Some IV fluids are in seriously short supply

Michael Cohen, president of the Institute for Safe Medication Practices, wrote this for the "Check Up" blog.

The country is experiencing a serious shortage of certain IV fluids, mainly involving 0.9 percent sodium chloride injection (IV saline) in 1,000-milliliter bags.

Some hospitals have also been short of lactated Ringer's solution, which replenishes fluids after trauma. Smaller bags are available now, but those supplies could dwindle.

This latest shortage seems to have begun in November but has worsened in the last few weeks and hospitals are scrambling. The U.S. market is served by Baxter (45 percent), Hospira (45 percent), and B. Braun (10 percent).

The acute situation is driven by more hospitalized flu patients along with a planned shutdown at Baxter for maintenance in December. The shortage is such that solutions are being allocated to customers already under contract.

It's unclear how long this shortage will last, but we're hearing that it will be several weeks at least, and for some solutions it will be into March or beyond. I've spoken to all three companies and they tell me they are working hard to get supplies back to normal.

Other IV solutions are available, but they may not always be appropriate for a particular patient. We could see shortages of these, too.

It's possible for hospital pharmacists to compound sodium chloride IV solutions. As this can raise the risk of compounding errors, it should be a last resort.

Also, if compounding becomes routine, it could lead to a critical shortage of the high-concentration sodium chloride (NaCl) products, which are already in short supply. A severe shortage also happened last year due to production issues at one of the generic injectable companies. A shortage of concentrated NaCl would affect use in patients who need nutrition by vein since it is a key ingredient in parenteral nutrition.

Hospitals are being urged to use oral hydration as much as possible, or to use smaller bags. IV sodium chloride solutions are often used in surgical patients or in diabetics who must limit dextrose intake.

So far we haven't heard of delays in elective surgery, but that could happen if things don't turn around soon.

The sodium chloride deficit is the latest in a series of drug shortages that peaked in 2010. In October, the Food and Drug Administration published a strategic plan to address drug shortages, and legislation was passed in 2012 that requires manufacturers to notify the FDA at least six months in advance when they are considering production shutdowns.

The FDA has also established an 11-person drug-shortage section. I see improvement overall, but shortages remain distressing, sometimes forcing less than adequate therapy and raising the risk of drug errors when caregivers must break routines or use unfamiliar products.

The FDA has sometimes allowed products to be imported to help alleviate the problem here. But that also presents problems because of differences in the way imported products are labeled, sometimes in a foreign language. There can also be differences in the exact ingredients and the strength per dosage unit. Although the import option may exist, it doesn't seem likely because of the size and weight of the heavy cartons, the huge amount of solutions that are used every week in the United States, and the likely enormous shipping costs.