Last week, the Australian Therapeutic Goods Administration (TGA) added intravenous (IV) fluids to the growing list of medicines in short supply. The shortage, attributed to higher-than-expected demand and manufacturing issues, affects two specific IV fluids: saline and compound sodium lactate (Hartmann’s solution), both of which are essential for patient care.
The shortage of saline and Hartmann’s solution is particularly concerning because these fluids are integral to various medical treatments. Saline is commonly used for hydration and as a vehicle for drug administration, while Hartmann’s solution is used to treat metabolic acidosis by balancing the body’s pH levels.
Why Not Switch to Alternatives?
Although there are IV fluids made with different components, such as sugar instead of salt, the TGA has opted to approve salt-based solutions from other overseas brands rather than switching patients to sugar-based IV fluids. This decision is grounded in the scientific principle of osmosis. Injecting pure water into a vein without the right balance of chemicals can disrupt the body’s osmotic balance, causing cells to either shrink (hypertonic state) or swell (hypotonic state). Therefore, IV fluids must closely match the body’s natural isotonic state to avoid these issues.
Types of IV Fluids
The most commonly used IV fluids include:
0.9% Saline: An isotonic solution of table salt.
5% Glucose/Dextrose Solution: Used when a sugar-based fluid is required.
Other specialized IV fluids combine saline and glucose or contain additional salts, such as:
Ringer’s Solution: Contains sodium, potassium, and calcium salts.
Plasma-Lyte: Contains various sodium salts and magnesium.
Hartmann’s Solution: Contains a range of different salts and is used for treating metabolic acidosis.
Risks of Using the Wrong IV Solution
Administering drugs in the wrong IV fluid can have serious consequences. For example, the chemotherapy drug cisplatin is safe in saline but can cause life-threatening kidney damage when administered in pure glucose. This highlights the importance of using the correct IV fluid for each specific drug to ensure stability and effectiveness while avoiding harmful side effects.
To mitigate the impact of the shortage, the Australian government has approved multiple alternative saline brands from overseas, bypassing the usual quality checks due to the urgent need. This move is intended to maintain the availability of essential IV fluids while ensuring patient safety. The Australian Society of Hospital Pharmacists provides guidance on which IV fluids to use for specific drugs, helping healthcare providers navigate the shortage effectively.
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