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Scott G Winterton, Deseret News
Margarito Morales sits with his wife, Lupe Corona, as he receives his medication by IV March 28, 2014, at the Huntsman Cancer Institute in Salt Lake City.
Remember that you have just generic companies providing these supplies across the country and all you have to do is have a little increased demand or a factory shut down and then all of a sudden you're in a shortage situation. —Scott Silverstein, Huntsman Cancer Hospital and Clinics

SALT LAKE CITY — One cancer patient arrives at the Huntsman Cancer Institute every Friday. The first thing she does is sit down to receive IV fluids for about an hour.

"I don't know what it would be like to not have them," Jenny McKane said. "I haven’t had treatment without the IV fluids but I would imagine that it would be less comfortable."

Some medical facilities in Utah and throughout the country are feeling their own discomfort. A shortage of the IV fluids, particularly saline solution used to give patients necessary fluids for hydration and other conditions, have led facilities like the Huntsman Cancer Institute to carry out conservation strategies, while other smaller clinics are working from shipment to shipment.

For McKane, an IV was her only method of hydration during a month, post-surgery, hospital stay where she was unable to eat or drink.

"It was essential to my health," she said.

"Fortunately I'm at the end of my treatments so it won't affect me much longer," she said. "But it would certainly affect other patients."

And there is little relief in sight.

Jared Nielson, a registered nurse at the Utah Hematology Oncology in Ogden, said the private clinic started feeling the pressure in January.

"I had tons in excess of what I needed," Nielson said. "I didn't have any more room to store cases, and now it's scrimp and scrimp to see what you can get."

He said the clinic has difficulty getting fluids; when they do it's rationed.

They now give patients half the usual amount of fluids. If it's not enough, the patient is taken to the hospital for more.

"Being hospitalized of course costs a lot more money than a bag of fluid," Nielson said.

A statement on the U.S. Food and Drug Administration's website says it is aware of the shortage of IV solutions "triggered by a range of factors including a reported increased demand by hospitals, potentially related to the flu season."

Three companies manufacture the IV fluids — Baxter Healthcare Corp., B. Braun Medical Inc., and Hospira Inc.

A letter from McKesson Medical-Surgical, a distributor of the B. Braun, Baxter and Hospira, to its customers had another explanation for the shortage.

"Increased FDA regulatory oversight and industry recalls have place a strain on manufacturers' ability to produce and supply unlimited quantities of IV solutions," the Jan. 10 2014 letter said.

Debrorah Spak, a spokeswoman for Baxter, said in an e-mail that the company is working to "alleviate the situation that has been caused by other companies' disruptions in supply."

The e-mail states Baxter increased production capacity by 3 percent in 2013.

Another letter addressed to IV solution purchasers from B. Braun, dated Dec. 27 2013, states the company is working to meet the "unprecedented increase in customer demand," and will increase production capacity by 60 percent over the next three years.

Scott Silverstein, director of pharmacy services at the Huntsman Cancer Hospital and Clinics, said by implementing conservation strategies he feels confident in their ability to care for patients.

"Right now the patients are not being affected because we’ve used these conservation strategies to assist us being able to, you know, be flexible with certain products," he said.

Those strategies include using smaller amounts of the fluids, encourage patients to hydrate by mouth and ordering the maximum amount of fluids allocated for the institute to automatically get shipments as it's available.

"Remember that you have just generic companies providing these supplies across the country and all you have to do is have a little increased demand or a factory shut down and then all of a sudden you're in a shortage situation," Silverstein said.

Silverstein said the institute has worked with the American Hospital Association and the Drug Information Center at the University of Utah to notify the FDA early and get on top of the situation.

Nielson said his sales representative told him there is no end in sight.

Nielson fears clinics won't be able to offer the best treatment for patients, and hospitals may follow suit.

"Our patients are sick. They have to have these treatments," Nielson said. "It does affect them when it gets to that level."

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