Sickle cell

Specialties Emergency

Published

Specializes in ER.

Ok...here's a question that I've asked frequently at work, but I'm not totally satisfied with the answers I get.

We seem to get sickle cell patients (whom many we find are not sickeling at the time) who come in to the ER for pain.

BUT..without fail, everyone of them will ask for dilaudid PLUS benedryl. Why benedryl? I have been told it was so they can get the extra high, but why do only sickle cell patients ask for benedryl with their pain med? Anyone else come across this??

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Specializes in Med/Surg.
Ok...here's a question that I've asked frequently at work, but I'm not totally satisfied with the answers I get.

We seem to get sickle cell patients (whom many we find are not sickeling at the time) who come in to the ER for pain.

BUT..without fail, everyone of them will ask for dilaudid PLUS benedryl. Why benedryl? I have been told it was so they can get the extra high, but why do only sickle cell patients ask for benedryl with their pain med? Anyone else come across this??

I thought it was because almost all narcotics, especially those in the morphine family can cause itching as a side effect.

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Specializes in Pediatrics, Cardiology, Geriatrics.

I agree with LouisVRN. Narcotics are known to cause itching. On a side note, please do not make the mistake that so many others (shamefully even nurses!) make and label sickle cell patients as drug seekers. Sickle cell anemia is excruciatingly painful, and a crisis can come on suddenly, especially if the patient is dehydrated. I had a wonderful nursing instructor who gave me quite a few sickle cell patients in clinicals, and I learned so much from them. It breaks my heart that family members, society, and even healthcare professionals do not show the compassion these tortured souls deserve. Some sickle cell patients have had their pain meds hidden from them by family because they do not understand how painful it is and have decided to pronounce them drug addicts. It's sickening.

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1.) Itching caused by narcotics.

2.) Because sleeping is better than being awake when you're hurting

3.) I have nothing to back this up, but in my experience, benadryl does seem to potentiate the effect of narcotics. And considering I've been told by pain team docs to throw benadryl into the mix on pain patients, I'm thinking they must think so too.

And it doesn't get anybody "high." Anyone that thinks that needs to go to the drugstore and buy some diphenhydramine, take a couple pills and come back and tell me how high they get.

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(whom many we find are not sickeling at the time)

Out of curiosity, how exactly do you find that they aren't "sickeling" at the time?

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Specializes in ER.
Out of curiosity, how exactly do you find that they aren't "sickeling" at the time?

I didnt know this till yesterday, but the Dr. ordered a "peripheral smear" on a patient (i could be wrong) who was in for sickle cell pain. We dont normally order it, but on this particular patient she did because their was question due to her history if she even had sickle cell. Apparently all her labs were normal and she came back negative for any sickleling cells (sp?)

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Specializes in ER.

I learned in nursing school that it is very very painful and I empathize. I can see how it would be easy to become dependent on pain medicine. I just thought it was weird how only SC patients want benedryl with the dilaudid. Non sickle cell patients have never asked for it. Wouldnt phenergan do the same thing? I gave a patient phenergan with the dilaudid and she wanted more benedryl, but to me phenergan would work better. Its also a histamine. The doctor said the same thing.

My concern is not whether they are "drug seeking" Im just trying to figure out why they are the only ones who ask for benedryl. Itching--I get it, but everyone can have that reaction.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
And it doesn't get anybody "high." Anyone that thinks that needs to go to the drugstore and buy some diphenhydramine, take a couple pills and come back and tell me how high they get.

Maybe I'm a lightweight, but yes...Benadryl does get me high! I use the Children's formula! (Then again, DayQuil has caused me to hallucinate before...

And when I was having surgery, I had to receive Benadryl for narcotic-induced itching, so it's not just Sickle Cellers, but it makes sense that they ask for it. After all, they receive TONS of narcotics due to tolerance and they already know narcotics cause itching.

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Specializes in Pediatrics, Cardiology, Geriatrics.
I didnt know this till yesterday, but the Dr. ordered a "peripheral smear" on a patient (i could be wrong) who was in for sickle cell pain. We dont normally order it, but on this particular patient she did because their was question due to her history if she even had sickle cell. Apparently all her labs were normal and she came back negative for any sickleling cells (sp?)

Oh, well if she doesn't have any sickled cells, she most likely doesn't have it. It is possible for someone with sickle cell trait to have pain, but that would involve rapidly entering high altitudes or extreme dehydration, but there would be sickled cells present in the blood if that were to happen. I guess she would be a drug seeker, possibly, then. :mad: That's even worse than people ignoring a true sickle cell patient's pain. To pretend to have it to get pain meds is evil! As far as the benadryl goes, I looked it up in epocrates, and it does potentiate narcotics, so it would, indeed give the patient more pain relief, but I can't imagine it giving a high to anyone, unless they think feeling high is like having a bad hangover. I never could understand how anyone would want to get high on narcotics. They make me feel absolutely awful, so I avoid them. But that's just me, I guess.

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Specializes in ER.
I agree with LouisVRN. Narcotics are known to cause itching. On a side note, please do not make the mistake that so many others (shamefully even nurses!) make and label sickle cell patients as drug seekers. Sickle cell anemia is excruciatingly painful, and a crisis can come on suddenly, especially if the patient is dehydrated. I had a wonderful nursing instructor who gave me quite a few sickle cell patients in clinicals, and I learned so much from them. It breaks my heart that family members, society, and even healthcare professionals do not show the compassion these tortured souls deserve. Some sickle cell patients have had their pain meds hidden from them by family because they do not understand how painful it is and have decided to pronounce them drug addicts. It's sickening.

There is no way you would not get addicted to pain meds if you were constantly in pain. If I took narcotics everyday for a month, I would build up a tolerance I think. Its sad I agree, and yes they are dependent somewhat on pain meds.

But, we have had some patients come in claiming they are having a sickle cell crisis and labs are done which prove they are not in a crisis. The lying, making up fake names, telling nurses and dr's how to do their job, and deceitfulness is what is sickening. We do get a fair share who are in crisis, but they don't act that way...

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Specializes in Pediatrics, Cardiology, Geriatrics.

And when I was having surgery, I had to receive Benadryl for narcotic-induced itching, so it's not just Sickle Cellers, but it makes sense that they ask for it. After all, they receive TONS of narcotics due to tolerance and they already know narcotics cause itching.

I agree. They have usually dealt with it for so long, they probably know to ask for Benadryl. I'm sure other chronic pain sufferers know that, too, but maybe the OP hasn't had any patients like that? I read that Phenergan can cause dehydration, so that would intensify a sickle cell crisis. Maybe some patients have had that reaction and feel Benadryl is safer?

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Specializes in ER.
Oh, well if she doesn't have any sickled cells, she most likely doesn't have it. It is possible for someone with sickle cell trait to have pain, but that would involve rapidly entering high altitudes or extreme dehydration, but there would be sickled cells present in the blood if that were to happen. I guess she would be a drug seeker, possibly, then. :mad: That's even worse than people ignoring a true sickle cell patient's pain. To pretend to have it to get pain meds is evil! As far as the benadryl goes, I looked it up in epocrates, and it does potentiate narcotics, so it would, indeed give the patient more pain relief, but I can't imagine it giving a high to anyone, unless they think feeling high is like having a bad hangover. I never could understand how anyone would want to get high on narcotics. They make me feel absolutely awful, so I avoid them. But that's just me, I guess.

I totally agree...I have never even had a narcotic, they must be pretty good considering the amount of people who walk in demanding more and more! All the dr.s I've asked have said it potentiates narcotics. How come all the drug seekers we see in the ER haven't figured this out?? lol We give alot of phenergan with pain which is alot like benedryl, but the sickle cell patients dont like it. I dont know. Im so glad that the dr. last night had the b**** to run the test. I'd like to treat people who are truly sick and in pain....:mad:

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