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Hospitals are running out of saline. It’s a global problem : ScienceAlert

Posted on by darion

Last week, the Australian Therapeutic Goods Agency added intravenous (IV) fluids to the growing list of drugs in short supply. The shortage is due to higher-than-expected demand and production issues.

Two specific intravenous fluids are affected: normal saline and complex sodium lactate (also called Hartmann’s solution). Both fluids are made of salt.

There are IV fluids that use other ingredients, such as sugar, instead of salt. However, rather than switch patients to these fluids, the government has decided to approve salt-based solutions from other foreign brands.

So why do IV fluids contain different chemicals? And why can’t you just swap them out when one runs out?

We can’t just inject water into a vein

Medicines are always injected into the veins in a water-based solution. But we can’t do this with pure water, we have to add other chemicals. This happens because of a scientific principle called osmosis.

Osmosis occurs when water moves rapidly into and out of cells in the bloodstream, in response to changes in the concentration of chemicals dissolved in the blood plasma. Think salts, sugars, nutrients, drugs, and proteins.

Too much of the chemicals and proteins in the blood causes it to be in a “hypertonic” state, which causes the blood cells to shrink. Not enough of the chemicals and proteins in the blood cause the blood cells to expand. The right amount is called “isotonic.”

Mixing the medication with the appropriate amount of chemicals, via injection or infusion, ensures that the concentration inside the syringe or intravenous bag remains close to isotonic.

What types of intravenous fluids are there?

There are a number of intravenous fluids available for administering medications. The two most popular are:

  • 0.9% saline, which is an isotonic solution of table salt. This is one of the intravenous fluids that are missing
  • 5% glucose/dextrose sugar solution. There is no shortage of this fluid.

There are also intravenous fluids that combine saline and glucose, as well as intravenous fluids containing other salts:

  • Ringer’s solution is an intravenous fluid containing sodium, potassium and calcium salts.
  • Plasma-Lyte contains various sodium and magnesium salts.
  • Hartmann’s solution (a complex of sodium lactate) contains a number of different salts. It is usually used to treat a condition called metabolic acidosis, in which patients have an increased amount of acid in their blood. It is low.

What if you use the wrong solution?

Some medications are only stable in specific intravenous fluids, for example only in saline-based intravenous fluids or only in glucose.

Putting the medication in the wrong IV fluid could potentially cause the medication to “run out” of solution, meaning patients will not receive the full dose.

The drug can also break down: not only will it not work, but it can also cause serious side effects.

An example where a drug can be converted into something toxic is the cancer chemotherapy drug cisplatin. It is safe when given in saline, but when given in pure glucose it can cause life-threatening damage to the patient’s kidneys.

What can hospitals use instead?

The IV fluids in short supply are saline and Hartmann’s solution. These are supplied by three approved Australian suppliers: Baxter Healthcare, B.Braun and Fresenius Kabi.

The government’s solution is to approve a number of overseas-registered alternative saline brands, which are permitted under current regulations without going through the normal Australian quality control and approval process. They will receive approval in the country of manufacture.

The government is taking this approach because it may not be effective or safe to formulate drugs that are intended to be in saline into different intravenous fluids. And we do not have the manufacturing capacity to produce saline intravenous fluids here in Australia.

The Australian Society of Hospital Pharmacists provides guidance to other healthcare professionals on which drugs should be given with which intravenous fluids in their Australian Injectable Drugs Handbook. If saline or Hartmann’s solution is out of stock and supplies of other overseas brands have not arrived, this guidance can be used to select an alternative suitable intravenous fluid.

Why don’t we produce it locally?

The current shortage of intravenous fluids is another example of the problems Australia is facing as it becomes almost entirely dependent on overseas manufacturers for key medicines.

Fortunately, we have workarounds to deal with the current shortage. However, Australia is likely to face ongoing shortages, not just of IV fluids but of all the medicines we rely on overseas manufacturers to manufacture. Shortages like these put Australian lives at risk.

In the past, I and others have called on the Federal Government to develop or support the development of Australian drug manufacturing. This could include off-patent drug manufacturing, with particular emphasis on the drugs most commonly used in Australia.

Not only would this create sustainable high-tech jobs in Australia, it would also positively impact our economy and make us less vulnerable to future global medicine supply issues.Conversation

Nial Wheate, Professor and Director of Academic Excellence, Macquarie University, and Shoohb Alassadi, Research Fellow, Pharmaceutical Sciences, University of Sydney.

This article is reprinted from The Conversation under a Creative Commons license. Read the original article.