The Dilemma of Fluid Management in Acute Kidney Injury During Sickle Cell Crises: A Case Report

Abstract

Fluid therapy remains a cornerstone in the management of sickle cell crises, as adequate hydration reduces blood viscosity and limits further sickling. However, in the presence of oliguric Acute Kidney Injury (AKI), fluid administration becomes a delicate balance to prevent volume overload and worsen morbidity. The case is that of an 8-year-old known sickle cell anemic boy who presented with fever and bone pain for 3 days, jaundice, and passage of dark brown urine. He was pale, icteric, and had non-tender hepatomegaly. He was managed for Vaso-occlusive crisis (VOC) and hyperhaemolytic crisis due to presumed sepsis. He had a blood transfusion and was subsequently placed on intravenous fluids 5% Dextrose in 0.9% Saline at 120% of maintenance. He developed Acute Kidney Injury (AKI) with oliguria (urine output 0.3ml/kg/hr), elevated serum urea (17.70mmol/L), creatinine (241.4µmol/L), and hyperkalemia (K 5.58mmol/L) by the following day on admission. His systolic blood pressure ranged from 140 to 100mmHg, while the diastolic ranged from 100mmHg to 60mmHg. In view of the oliguric AKI, the intravenous fluid was reduced to 2/3rd of maintenance fluid using 5% Dextrose Saline, while the remaining 1/3rd was given orally. He was given furosemide with alkalization of the urine. His urine output and vital signs were closely monitored, and hyperkalemia and hypertension were managed appropriately. By the end of the first week of admission, there was significant improvement in renal parameters, and urine output normalized. The blood pressure at discharge was 90/60mmHg. In conclusion, balancing adequate hydration to prevent further sickling must be weighed against the risk of fluid overload and worsening renal dysfunction in co-existing AKI.