Helene spurs IV fluid shortage. Milton could make it worse

Hospitals across the U.S. are feeling the impact of Hurricane Helene as experts warn of an imminent intravenous (IV) solution shortage due to the temporary shutdown of a facility in a North Carolina.

And Hurricane Milton’s approach could worsen the problem, with another key IV fluid manufacturing facility located along its potential path in Florida.

Baxter International’s IV fluid manufacturing facility in Marion, N.C., supplied roughly 60 percent of the IV solution used by hospitals in the U.S. every day until Helene temporarily halted operations. 

While what remained at Baxter’s facility has begun to be shipped out, production may not restart for another week or two. The company says its global plants are ramping up production in response. 

Just a week after Helene dissipated, hospitals say they’re already beginning to feel the strain of Baxter’s temporary halt in production. 

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association (AHA), told The Hill that hospitals nationwide that rely on Baxter have been told to expect 40 percent of their normal shipments of IV solution. 

“And that’s all that will be available to them until the situation begins to improve,” she said. 

According to Foster, this means that hospitals will have to think conservatively in terms of how they use IV fluids, prioritizing certain patients who “absolutely need” those solutions and utilizing alternative methods for others.  

She noted 17 different products were manufactured at the North Carolina plant, mostly different types of saline but also products like ringer’s lactate, which support patients’ bodily function. 

The AHA has called on the Biden administration to declare a shortage of IV solutions, both so that hospitals can prepare IV solutions in their own pharmacies and to signal to health care providers that they must conserve their supply.  

Concerns are culminating just as Milton is set to make landfall in Florida this week. 

B. Braun, another top IV solution manufacturer in the U.S., has a facility in Daytona Beach, Fla. Both federal officials and the company are well aware that the plant is within Milton’s expected path.  

A spokesperson for the Administration for Strategic Preparedness and Response (ASPR) said it is coordinating with B. Braun “to move their product out of the path of the storm and facilitate other activities that will mitigate potential impacts on future distribution.”

B. Braun’s Daytona Beach facility was not affected by Hurricane Helene. It is closing its Florida manufacturing plant and distribution center Wednesday morning in anticipation of Milton, with plans to resume operations on Friday, Oct. 11. 

Alli Longenhagen, director of corporate communications at B. Braun, confirmed her company is working with ASPR to transfer its Florida inventory to a “secure, temperature-controlled facility, north of Florida.” 

“Once the storm passes, the product will return to the distribution center,” said Longenhagen. 

“The Daytona Beach facility is a key part of our plan to help address the shutdown of Baxter’s IV solutions manufacturing facility in North Carolina,” Longenhagen added. “In partnership with ASPR, we are taking immediate steps to increase production of critical IV fluids at our plant in Irvine, CA, and will resume this plan at Daytona Beach following Hurricane Milton’s departure.” 

Rep. Debbie Dingell (D-Mich.) has called on the Department of Health and Human Services (HHS) to further strengthen supply chains to prevent an IV fluid shortage. 

“Natural disasters often have effects beyond the horrific destruction and loss of life throughout the southeastern part of our country,” Dingell said in a letter to HHS. “This supply chain disruption is a grave reminder of the interconnection of our government and society — maintaining communication and cooperating through these adversities is the best solution to care for our communities.” 

According to a senior Biden administration official, the Food and Drug Administration (FDA) is considering potential options to address the issue, including temporary imports and expedited reviews. 

The American Society of Health-System Pharmacists (ASHP) said in a statement Tuesday that it backed the plan for expedited importation from foreign plants.

The ASHP had a meeting with the FDA and the White House to discuss the looming issue in which the organization said it called for “temporary flexibility” on FDA requirements like inspections, limits on compounding and an extension on expiration dates for IV fluids and peritoneal dialysis solutions. 

In cases of IV solution shortage, hospitals have contingency plans in place, but Foster noted that the traditional course of action is usually to ask other hospitals to share their supplies. This plan doesn’t work when the supplier is out of commission.

“It’s this taking out of the source that’s created the real challenge for hospitals and others regarding the use of these IV solutions right now,” said Foster. 

Another measure being considered to mitigate a shortage is to have other manufacturers ramp up production.

ICU Medical, a major IV solutions manufacturer, said it was unaffected by Helene and continues to operate as normal.

“We are continuing to collaborate with government agencies while actively monitoring potential increases in demand for IV solutions and have already taken necessary steps to increase production to help meet market needs while continuing to support our existing customers,” it said in an emailed statement. 

The incoming respiratory viral season adds an additional layer of pressure on hospitals. Hospitalizations go up as flu, RSV and COVID spread, and ensuring that hospitalized patients remain sufficiently hydrated is a key part of treatment.