Saline Shortages — Many Causes, No Simple Solution

Mazer‐Amirshahi, Maryann; Fox, Erin R.

doi:10.1056/nejmp1800347

Cited by 59 publications

(61 citation statements)

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“…During recent IV fluid shortages, some hospitals have reserved IV fluid treatment for critically ill patients, while utilizing oral rehydration protocols for ED patients who would have previously received IV fluids. 22,23 Future studies could evaluate the effect of different rehydration protocols, such as a comparison of oral rehydration and IV fluid treatments, on quality of recovery in these ED patients. Moreover, our secondary outcomes, while underpowered, demonstrated a notable ED re-visit rate during the first seven days following discharge.…”

Section: Discussionmentioning

confidence: 99%

Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial

Friederich

Martin

Faine

et al. 2019

Annals of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial

Friederich

Martin

Faine

et al. 2019

Annals of Emergency Medicine

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“…However, the FDA cannot require a manufacturer to produce any product, no matter how lifesaving, and has no authority to require manufacturers to have redundancies or contingency plans in case of shortages [19]. Importing medications from other countries is an option to help mitigate shortages; however, this temporary strategy may only be used when a sufficient supply is available without creating a shortage in another country [20]. …”

Section: Discussionmentioning

confidence: 99%

Prescription Drug Shortages: Impact on Neonatal Intensive Care

et al. 2018

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Background: Prescription drug shortages have increased significantly during the past two decades and also impact drugs used in critical care and pediatrics. Objectives: To analyze drug shortages affecting medications used in neonatal intensive care units (NICUs). Methods: Drug shortage data for the top 100 NICU drugs were retrieved from the University of Utah Drug Information Service from 2001 to 2016. Data were analyzed focusing on drug class, formulation, reason for shortage, and shortage duration. Results: Seventy-four of the top 100 NICU drugs were impacted by 227 shortages (10.3% of total shortages). Twenty-eight (12.3%) shortages were unresolved as of December 2016. Resolved shortages had a median duration of 8.8 months (interquartile range 3.6–21.3), and generic drugs were involved in 175 (87.9%). An alternative agent was available for 171 (85.8%) drugs but 120 (70.2%) of alternatives were also affected by shortages. Parenteral drugs were involved in 172 (86.4%) shortages, with longer durations than nonparenteral drugs (9.9 vs. 6.4 months, p = 0.022). The most common shortage reason was manufacturing problems (32.2%). Conclusions: Drug shortages affected many agents used in NICUs, which can have quality and safety implications for patient care, especially in extremely low birth weight infants. Neonatologists must be aware of current shortages and implement mitigation strategies to optimize patient care.

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“…Of note, vulnerabilities in the intravenous fluid supply in the US have existed for several years, prompting some hospitals to develop protocols for oral rehydration in patients with dehydration 6170. Although these protocols have not been specifically tested in patients with diabetic ketoacidosis, this strategy can be considered in selected patients with mild-moderate diabetic ketoacidosis when accompanied by appropriate monitoring for therapeutic efficacy 61…”

Section: Acute Managementmentioning

confidence: 99%

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

127

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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Saline Shortages — Many Causes, No Simple Solution

Cited by 59 publications

References 1 publication

Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial

Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial

Prescription Drug Shortages: Impact on Neonatal Intensive Care

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

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