The United States is currently grappling with a severe shortage of intravenous (IV) fluids as a result of recent natural disasters. The primary cause of this shortage can be traced back to Hurricane Helene, which struck in late September 2024, causing significant damage to Baxter International’s manufacturing plant in Marion, North Carolina. This facility, responsible for producing approximately 60% of the nation’s IV fluids, was forced to temporarily shut down due to flooding, triggering a ripple effect across the healthcare system. In light of the pervasive effects of an IV fluid shortage on the healthcare system, individual facilities, professional societies, and government agencies have been working to provide guidance on managing the shortage.

IV fluids play a crucial role in healthcare, serving a wide range of medical purposes. They are primarily used for rehydration, resuscitation, and maintenance of fluid balance in patients who cannot take fluids orally or require rapid fluid replacement. In surgical settings, IV fluids help maintain patients’ hydration, electrolyte, and blood sugar levels during procedures, while also allowing for the administration of anesthesia, pain medications, and antibiotics. For patients with malnutrition or those unable to meet their nutritional needs orally, IV fluids can provide partial or total parenteral nutrition. In emergency situations, IV therapy is essential for rapidly administering medications, blood products, or fluids to treat conditions such as heart attacks, strokes, trauma, severe allergic reactions, and infections.

The impact of this shortage on patient care has been substantial. Many facilities across the country have been forced to delay non-urgent surgeries and implement strict conservation measures. Some facilities have implemented policies to substitute IV fluid hydration with oral electrolyte fluids, such as Gatorade or Pedialyte, where possible. The shortage affects a range of critical IV products, including normal saline, sterile water for irrigation, and dextrose solutions, all of which are essential for various medical procedures and treatments.

From a healthcare administration perspective, managing this shortage requires a multifaceted approach. Guidance from the U.S. Department of Health and Human Services (HHS) has urged facilities to implement organization-wide IV fluid conservation plans to ride out the shortage until supply can be increased. These strategies include prioritizing vulnerable populations with specific needs, such as pediatric and neonatal patients, and substituting clinically equivalent products when appropriate.

Administrators are also advised to work closely with their supply chain teams to diversify their sources of IV fluids. While Baxter is the dominant supplier, other manufacturers like B. Braun Medical, ICU Medical, and Fresenius Kabi also produce these essential products. The federal government has also taken steps to mitigate the shortage, as the FDA has permitted the temporary importation of 19 different IV products from countries including Canada, China, Ireland, and the United Kingdom. Additionally, the Defense Production Act has been invoked to assist Baxter in securing materials for cleaning and reconstructing its facility.

Despite these efforts, the road to recovery may be long. Baxter has increased allocations for its highest-demand IV fluids from 40% to 60% for direct customers and distributors, with the goal of returning to 100% allocation of certain IV solutions by the end of the year. However, the ongoing hurricane season and potential future disruptions continue to pose risks to the supply chain. In addition to guidance on managing the ongoing IV fluid shortage, discourse among the medical community has also called for improvements to the supply chain that prevent any one event from causing such massive disruption.

The current IV fluid shortage in U.S. hospitals, primarily caused by Hurricane Helene’s impact on a major manufacturing facility, has created significant challenges for patient care. Healthcare facilities must implement comprehensive conservation strategies, diversify their supply sources, and work closely with government agencies to navigate this crisis. As the healthcare system adapts to these challenges, it also highlights the need for long-term solutions to strengthen the resilience of critical medical supply chains.

References

1. American Society of Health-System Pharmacists. ASHP guidelines on managing drug product shortages. Am J Health Syst Pharm. 2024;81(20):1742-1750.

2. Baxter International Inc. Baxter provides update on IV solutions manufacturing following Hurricane Helene [press release]. September 30, 2024. https://www.baxter.com/baxter-newsroom/baxter-provides-update-iv-solutions-manufacturing-following-hurricane-helene

3. Food and Drug Administration. FDA updates on IV fluid shortages. October 1, 2024. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages

4. U.S. Department of Health and Human Services. HHS guidance for hospitals on managing IV fluid shortages. October 5, 2024. https://www.hhs.gov/guidance/document/managing-iv-fluid-shortages-hospitals

5. World Health Organization. Global impact of IV fluid shortages: A situation report. WHO Bull. 2024;102(10):715-722.

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