Medicine, Feds Still Urge Conservation Amid IV Fluid Shortage
By Phil West

Without a clear resolution on the horizon, the Texas Medical Association and American Medical Association continue to urge conservation in response to a nationwide shortage of IV fluids stemming from Hurricane Helene-related damage to the country’s main manufacturing site. Medicine is communicating with state and federal authorities as they monitor the situation. 

TMA President G. Ray Callas, MD, says he is in talks with the Texas Division of Emergency Management about “what [Texas is] doing for fluid allocation, and we're looking at everything that we can get our hands on, because the state of Texas always is involved,” adding the state is looking to “maintain the integrity of our hospital systems and our health care system.” 

He urges physicians to convene with local medical staff and administrators to remain conscientious about IV fluid supply. In his own Beaumont-based anesthesiology practice, Dr. Callas says he and his colleagues are utilizing more oral hydration and being more selective about using IV fluid use for patients, echoing reports of hospitals and health care professionals across Texas assessing, planning, and utilizing conservation strategies. 

“It’s better to be saving now and not jeopardizing care if you need it later. Even with all these measures, it may still be months before we reach full production of these fluids,” Dr. Callas cautioned, adding that TMA is involved in efforts to spread the word to Texas physicians.   

Meanwhile, AMA reports it has contacted the Biden administration on the issue, following the U.S. Department of Health and Human Services’ (HHS’) announcement it is working with manufacturer Baxter International and the Food and Drug Administration (FDA) to address the shortage. The Biden administration has since responded by invoking the Defense Production Act to enable a more expedient rebuilding of the North Cove, N.C. manufacturing site. 

AMA says FDA Commissioner Robert Califf, MD, wants to hear about any local-level problems and encourages physicians to contact their AMA field representatives to report areas experiencing challenges. (Texas members can contact Joaquin Falcon.) 

AMA said it “will continue to monitor the situation and weigh in with HHS as appropriate.”     

Melissa Garretson, MD, a Fort Worth pediatric emergency physician and member of AMA’s Board of Trustees, is encouraged by communication between government and medicine thus far.  

“The fact that we've gone now two weeks and managed to continue to care for patients in a very appropriate way makes all of us feel a little bit more comfortable,” she told Texas Medicine Today.  

That said, she too, urges conservation efforts in line with federal action.  

“Being more judicious … will help us extend our supplies that we already have and for a longer period of time,” especially given that flu season is approaching.  

North Cove produced an estimated 60% of IV solutions in North America prior to Hurricane Helene’s impact on the facility. As of this writing, FDA has added three drug products to its shortage list – dextrose 70% IV solution, lactated ringers IV solution, and peritoneal dialysis solution.  

Baxter announced on Oct. 9 it was increasing the current U.S. allocation levels of its highest-demand IV fluids for direct customers from 40% to 60%, and for distributors from 10% to 60%, as it works to fully restore North Cove operations.  

HHS noted in its letter to health care leaders that same day that it is addressing supply chain disruptions, and its update two days later noted that FDA is temporarily importing IV products from five international sources as well as encouraging production ramp-ups from U.S. facilities. 

The agency has also issued a list of conservation strategies for hospitals and health care professionals.