Background

Earlier this month, Baxter International's IV fluid manufacturing facility in Marion, North Carolina, was temporarily shut down following Hurricane Helene. The facility supplies around 60% of the IV solution used by hospitals in the United States every day.

Nancy Foster, VP of quality and patient safety policy at the American Hospital Association (AHA), said that hospitals nationwide that rely on Baxter have been told to only expect 40% of their normal shipments. "And that's all that will be available to them until the situation begins to improve," she said.

This means hospitals will have to think conservatively about how they use IV fluids, Foster said, prioritizing certain patients who "absolutely need" those solutions and using alternative methods for others.

Baxter later announced on Wednesday that, given expected deliveries from its foreign plants — which FDA authorized Wednesday night — it would increase its release of supplies to 60% of normal levels. Baxter also said it aims to restart production at its facility in North Carolina in phases and "return to 90% to 100% allocation of certain IV solution product codes by the end of 2024."

Hurricane Milton had the potential to make the situation worse, as B. Braun, another major IV solution manufacturer, has a facility in Daytona Beach, Florida. Fortunately, the facility remained intact in the wake of Milton.

Before the hurricane made landfall, company workers and officials from the Administration for Strategic Preparedness and Response took preemptive measures, filling trucks with IV medical products and shipping them out away from the storm Tuesday night.

Allison Longenhagen, a spokesperson for B. Braun, said on Thursday the Daytona Beach site was intact and B. Braun confirmed Friday morning that both of its Daytona Beach sites had reopened.

The saline, dextrose, and sterile water fluids produced by these plants have a number of uses in healthcare, including providing basic hydration before surgery or childbirth. They can also be mixed with nutrients and medications, including chemotherapies, are frequently used in life-supporting infusions for prematurely born babies, and are critical for treating sepsis and for patients who perform dialysis at home.

"When you're coming in with sepsis, and specifically the septic shock, those one-liter bags are the most immediate form of treatments, and sometimes you're getting two, if not three, of them in rapid succession," said Chris DeRienzo, chief physician executive of AHA. "There are so many special populations impacted by the shortage, what it really leads to is an impact on the whole population."

How hospitals are responding to the shortage

According to a survey conducted by Premier, 86% of healthcare providers are experiencing shortages of IV fluids, and smaller providers are the most likely to not have received any IV solutions they ordered last week. Roughly half of providers have 10 days or less of fluid supplies, down from an average of 15 to 22 days of supplies.

FDA on Friday officially declared shortages of three IV drugs that were produced at Baxter's North Carolina plant:

• Dextrose 70% IV Solution
• Lactated Ringers IV solution
• Peritoneal Dialysis Solution

Dextrose 70% IV solution and Lactated Ringers IV Solution are both used to rehydrate patients, while Peritoneal Dialysis Solution is used or patients with acute or chronic kidney failure and require a dialysis machine.

HHS has urged hospitals to compound their own fluids as a way to temporarily ease the shortage, and FDA's declaration of a shortage provides hospital pharmacies with the flexibility to prepare their own IV solutions while also making sure providers know to conserve their supply.

Some hospitals are coming up with creative solutions to manage the shortage. Hospitals in the Main Line Health hospital chain in Philadelphia have started giving less critically ill patients Gatorade and other electrolyte solutions rather than hanging IV bags, while other hospitals are giving patients medicine orally instead of through IV drips.

Northwestern Medicine said it's working to shore up a supply of IV fluids for the roughly 90 patients who do dialysis at home. Vikram Aggarwal, medical director of the home dialysis program, said no new patients could be added for now.

"We are triaging; we are trying to risk-stratify," he said. "Another one to two weeks with this shortage, it could be a matter of concern."

Mike Waldt, system director of pharmacy for North Memorial Health in Minnesota, said the IV shortage has "been a pretty dramatic impact for us."

Waldt said North Memorial has yet to postpone any elective procedures because of the shortage but is adjusting its protocol to conserve what supply it has, including administering antibiotics through a "push" or direct syringe rather than an IV bag, and asking patients to hydrate before they visit.

Allina Health and M Health Fairview said they've temporarily rescheduled some non-emergency surgeries "to ensure patients who have the most urgent needs get the care they need."

Similarly, Mass General Brigham announced it will postpone certain non-emergent, elective procedures beginning Sunday until at least Wednesday. Mass General emphasized that only procedures requiring the specific types of IV fluids would be affected.

Andrew Pasternak, a family medicine physician at Silver Sage Center for Family Medicine in Nevada, said he's received notifications from local hospitals about IV shortages and said the shortage will affect many of his patients who have scheduled surgeries or need IV fluids for their chemotherapy.

In an op-ed for STAT, Pasternak urged elective IV hydration bars and spas to shut down until the shortage is over.

"During this IV emergency, it is frankly a waste to help someone feel better from their hangover, while critically ill patients may experience delays in care," Pasternak wrote. (Jewett, New York Times, 10/9; Cummings, CBS News, 10/8; McFarling, STAT, 10/9; Pasternak, "First Opinion," STAT, 10/9; Jewett, New York Times, 10/10; Kansteiner, Fierce Pharma, 10/10; Choi, The Hill, 10/11; NBC Boston, 10/13; Zipp, HealthcareDive, 10/10)

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