The IV Fluid Shortage: The Struggle is Real
If you are a PA working in a hospital setting, you are no stranger to the recent increase in emails discussing the national shortage of medications. While there are numerous reasons for this, it all boils down (pun intended) to supply and demand. In the emergency department, IV fluids have recently hit the list of shortages. Our 1-liter bags are now 500mL bags, our medications now have to be mixed a la carte and brought down to the ER to ration supplies.
We love IV fluids in the ER, it can be the cure-all for migraines, gastroenteritis, influenza, viral URIs, pneumonia, even asthma patients benefit from fluids sometimes. In the pediatric ED, we reserve fluids routinely but sometimes you just need to make the kid perk up. The notion that fluids “just make people feel better” is not anecdotal in the emergency department- people with headaches and viruses are often dehydrated, nauseous and feel crummy as a result. Within the hospital, normal saline is used every day, on every unit, for the majority of admitted patients. We are about to run into a major issue and there wasn’t an evidence-based alternative.
The NEJM published an article: Facing the Shortage of IV Fluids — A Hospital-Based Oral Rehydration Strategy outlining an evidence-based oral re-hydration protocol for adults that is a great alternative to the nontoxic appearing adult who needs a little “pick me up”, and not real volume resuscitation.
The process is simple, drink 30mL every 3-5 minutes as tolerated. That’s it. They suggest offering a variety of drinks such as juices, electrolyte-containing sports drinks or ginger ale. The protocol is simple, addresses the importance of pain control and anti-emetics, and provides a troubleshooting guide as well. If the patient vomits, wait 20 minutes and try again. If there are no complications, the patient should have 1 Liter of fluids ingested in 2hours and 40 minutes.
Although this is not new information, it is an evidence-based method to avoid IV fluids. In the current state of IV fluid affairs, it’s a nice alternative and one I will be sharing with my medical director. Cheers!
-C
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