OJCD  Vol.4 No.1 , March 2014
The Utility of Routine Electrolytes in Patients with Sickle Cell Anemia Presenting with an Acute Pain Crisis
Abstract: Background: The evaluation of sickle cell vaso-occlusive crisis may include the measurement of the patient’s CBC and reticulocyte count. Twelve clinical criteria have been previously published for patients at risk for electrolyte abnormalities, but a chemistry panel is often ordered as well occasionally without a true indication. Objectives: Our objective was to determine whether routine measurement of electrolytes can be safely avoided in patients with SCA who present to the ED with an acute painful crisis. Methods: This was a retrospective study of patients with SCA who presented with a painful crisis. All visits were considered separately. All medical records were reviewed for any electrolyte abnormalities and any treatment(s). Patients with an electrolyte abnormality had their medical record screened for the presence of specific criteria, and if any interventions or consultations were performed due to the results. Results: One hundred twenty-two unique patients were found to have one or more abnormal laboratory value over a total of 337 distinct patient visits, with a total of 686 abnormal values. Of these, only 2 laboratory values caused a change in treatment or disposition, both of which were replacement of potassium for hypokalemia. There were no consultations from the ED to any service other than the admitting team in any of the 337 distinct patient visits. Conclusions: For SCA patients presenting to the ED with a painful vaso-occlusive crisis, measuring electrolytes in the absence of another more specific and established clinical reason, is very likely unnecessary and can be safely avoided.
Cite this paper: K. Desai, B. (2014) The Utility of Routine Electrolytes in Patients with Sickle Cell Anemia Presenting with an Acute Pain Crisis. Open Journal of Clinical Diagnostics, 4, 22-26. doi: 10.4236/ojcd.2014.41005.

[1]   Cantrill, S.V. and Karas, S. (1994) The Appropriate Utilization of Chemistry Profiles, In: Cantrill, S.V. and Karas, S. Eds., Cost Effective Diagnostic Testing in Emergency Medicine, American College of Emergency Physicians, Dallas, 67-73.

[2]   Marx, J.A., Hockberger, R.S., Walls, R.M., et al. (2010) Rosen’s Emergency Medicine. Concepts and Clinical Practice. Mosby Elsevier, Philadelphia, 1557-1577.

[3]   Solomon, L.R. (2010) Pain Management in Adults with Sickle Cell Disease in a Medical Center Emergency Department. Journal of the National Medical Association, 102, 1025-1032.

[4]   Embury, S.H. (2004) Sickle Cell Disease. In: Hoffman, R., et al., Eds., Hematology: Basic Principles and Practice, 4th Edition, Churchill Livingstone, New York.

[5]   Lopez, B.L., Griswold, S.K., Navek, A. and Urbanski, L. (1996) The Complete Blood Count and Reticulocyte Count—Are They Necessary in the Evaluation of Acute Vasoocclusivesickle-Cell Crisis? Academic Emergency Medicine, 3, 751-757.

[6]   Desai, B. and Seaberg, D.C. (2001) The Utility of Routine Electrolytes and Blood Cell Counts in Patients with Chest Pain. Academic Emergency Medicine, 19, 196-198.

[7]   Lowe, R.A., Arst, H.F., Ellis, B.K., et al., (1991) Rational Ordering of Electrolytes in the Emergency Department. Annals of Emergency Medicine, 20, 16-21.

[8]   Pollack Jr., C.V., Jorden, R.C. and Kolb, J.C. (1991) Usefulness of Empiricchestradiography and Urinalysistesting in Adults with Acutesicklecellpaincrisis. Annals of Emergency Medicine, 20, 1210-1214.

[9]   Rothrock, S.G., Green, S.M., McArthur, C.L., DelDuca, K. and Detection of Electrolyte Abnormalities in Children Observational National Study (DEACONS) Investigators (1997) Detection of Electrolyte Abnormalities in Children Presenting to the Emergency Department: A Multicenter, Prospective Analysis. Academic Emergency Medicine, 4, 1025-1031.