Spoiler alert… There is currently a shortage of intravenous fluids in the US. This knowledge may come in handy if your ED is beset by dehydrated St. Patrick’s Day revelers. Specifically supplies are constrained for both normal saline and lactated ringers, plus 5% dextrose solutions. I shouldn’t have to tell you that this is potentially a very big deal. There are 3 main manufacturers in the US –  Baxter Healthcare Corp., B.Braun Medical Inc., and Hospira Inc. The FDA has pegged the shortage as due to increased demand over the past several months during flu season. It may not be until the third quarter until supplies increase. So, what can you do other than mixing your own? Read on…

I’m kidding of course. Don’t mix your own, as that’s a bad idea for a number of reasons.

1. Only order fluids when necessary

Yes, I realize that giving a liter of normal saline can help restore intravascular deficit. I’ve also heard it being ordered in situations where it’ll “make mom feel better.” Note, that in this scenario the patient and mom are not the same person. The downsides to giving IV fluids in a well hydrated or only mildly dehydrated patient are few – but you still need to traumatize kids with an IV. And besides, poking a needle through someone’s skin isn’t exactly without risk.

I encourage, nay empower you to do a good physical exam including paying attention to heart rate, capillary refill, pulses, skin color and turgor, mucous membrane moistness, urine output and mental status. I’ve met many a patient who despite being “unable to keep anything down” and being “lethargic” leaves the room to pee during my exam and hands mom his portable video game system. In patients that can use their gut to get/stay hydrated – USE IT! We need to educate patients and families on what dehydration is and only administer IV fluids when needed. This should occur in the absence of a fluid shortage of course – but the current situation brings it more into focus doesn’t it. I’ll post more on the assessment of hydration soon.

2. Don’t use IV fluid bags and flushes when running/participating in sims

I’m all for treating in situ or lab-based sims as faithful to the real life environment as possible. Right now, we should make affordances for the fluid shortage and develop alternative solutions – or use alternative solutions. One that I recommend is dihydrogen monoxide. It is cheap, readily available and has similar fluid dynamics as normal saline. It is also good at treating dehydration as well. You can simply fill a basin with water and fill syringes to use as flushes, or even take an old bag and fill that up. Regardless of the scenario and set up it makes absolute sense to conserve until supplies improve.

3. Get the word out to colleagues, other Emergency Departments and practices in the community

We are lucky to have a pharmacist in our ED that stays on top of shortages and gets the word out. Please do the same to your colleagues who work elsewhere. The only way we can have fluids for the patients that truly need them is by not wasting them in situations where we don’t.

Hopefully this news does not come as a surprise. But if it does use it as an opportunity to better educate your peers, patients and families on hydration status and the value of a good physical exam as well as the benefits of a functioning gut (and perhaps a dose of ondansetron) in oral rehydration therapy.