I recently realised I wasn't the only one that had noticed this change.

In the past… IV fluids were almost automatic.

You came in with a crisis… you were written up for regular IV fluids.

Simple.

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But now… many hospitals don’t give IV fluids routinely anymore.

Which left Sickle Cell patients of a certain age like me abit confused.

You'd think IV fluids would be one of the key benefits of being in hospital. Especially when you’re in pain and struggling to drink enough to keep yourself hydrated.

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So what’s changed?

Doctors are trying to be more careful with fluids.

Because too much IV fluid can actually cause harm…

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This risk isn’t always explained clearly. But because sickle cell often causes chronic anaemia, the heart may already be working harder than usual. So if too much fluid is given too quickly through a drip, it can overload the circulation and lead to fluid building up in the lungs.

And this can then increase the risk of serious complications like acute chest syndrome.

So instead of giving IV fluids to everyone, the approach now is:

Encourage oral fluids first and only use IV fluids if they’re really needed.

On paper… this makes sense.

But it relies on two big assumptions:

1. That if you can’t drink enough, someone will notice quickly and act.
2. If you’re told to drink, you’ll actually have consistent access to oral fluids.

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In real life, that doesn’t always happen.

You might be in severe pain, struggling to drink, or even vomiting… but it takes hours for IV fluids to be prescribed.

Or you want to drink… but your water jug is empty, and no one has had time to refill it.

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So from your perspective, it can feel like you’re getting neither.

And that’s where the frustration comes from.

Because even though fluid overload is a real risk… dehydration still matters in sickle cell.

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What you can do?

The key idea here is balance.

Not 'no IV fluids', Not 'IV fluids for everyone'

But the right approach for you.

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At your next outpatient appointment, ask a simple question:

“What’s my hydration plan if I’m in hospital?”

This should be decided and explained in the context of your personal medical history.

It should be clearly stated on your care plan to aid doctors in prescribing IV fluids for you if you need them.

And if you do end up in hospital unwell and struggling to drink, say clearly:

"I’m finding it hard to stay hydrated. Can we reassess whether I need IV fluids?"

You’re not asking for something extra.

You’re asking for appropriate care.

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Stay Healthy,

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Lewis