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| 08:51 AM | ||
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| 08:51 AM | ||
Severe IV fluid shortage threatens hospital and health care in the US | |
| Anonymous Coward User ID: 25284379  United States06/10/2014 10:16 AM Report Abusive Post Report Copyright Violation | |
| emerald eye
(OP) Keeping an "eye out" for the truth.  User ID: 39877195 United States06/10/2014 10:29 AM  Report Abusive Post Report Copyright Violation | ... Quoting: emerald eye Yes, you are quite correct. A competent pharmacist or chemist can compound the salt and water mixture, but nobody has done that for many years, and it would take a while to get up to speed on it. They used to hang glass bottles of the stuff in IV’s, as glass is easy to sterilize, but these are inconvenient for patient care and can break, producing dangerous glass shards. Now we have sterile plastic bags that are quite strong and usually don’t leak or break. We don’t have easy access the materials to make the large quantities required by most hospitals in house. You would need to pressure boil the water to sterile it from some pathogens, simple boiling would not be enough for IV use. Here is the recipe: “The solution is 9 grams of sodium chloride (NaCl) dissolved on water, to a total volume of 1000 ml. As 1 grams NaCl occupies 0.18 level teaspoons, 9 grams NaCl is 1.62 level teaspoons. The mass of 1 millilitre of normal saline is 1.0046 gram at 22 °C.[2][3] The molecular weight of sodium chloride is approximately 58.5 grams per mole, so 58.5 grams of sodium chloride equals 1 mole. Since normal saline contains 9 grams of NaCl, the concentration is 9 grams per liter divided by 58.5 grams per mole, or 0.154 mole per liter. Since NaCl dissociates into two ions – sodium and chloride – 1 molar NaCl is 2 osmolar. Thus, NS contains 154 mEq/L of Na+ and Cl−. It has a slightly higher degree of osmolarity (i.e. more solute per litre) than blood (However, if you take into account the osmotic coefficient, a correction for non-ideal solutions, then the saline solution is much closer to isotonic. Osmotic coefficient of NaCl is about 0.93; therefore 0.154 × 1000 × 2 × .93 = 286.44) Nonetheless, the osmolarity of normal saline is a close approximation to the osmolarity of NaCl in blood.” [link to en.wikipedia.org] The shortage speaks to supplies being diverted for anticipated mass casualty events, (war, martial law, civil unrest with riots and injury) within two years of the beginning of the shortage in Dec 2012 to January 2013. Now the predictions are that the shortage will continue until 2015. Are 2014-2015 the pivotal years for something that is being anticipated? That is why I wanted to get this information out to GLP. I have learned so much from all of you, I always feel honored to share what I know with GLP.  Are you a medical worker - OP? Yes, and while I can tell you that many items are in short supply and have been for the past 2-3 years, this has a wider impact, so it is somewhat different. Shortages in medical supplies have become the "new normal". Do you work in a hospital - OP? Yes, I work in a surgical specialty, but that is all the detail that I feel comfortable giving. You know how the internet can be.  Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 12:20 PM Report Abusive Post Report Copyright Violation | Testing to see why I can't post something related. Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 12:22 PM Report Abusive Post Report Copyright Violation | It must contain some banned words, but for the life of me, I can't figure out why it won't post and after making several revisions, I still can't get it to post. Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 12:25 PM Report Abusive Post Report Copyright Violation | I figured it out, it was the link, so I changed the link. Let's see if this will work: Actually in my earlier list, of why someone would want large quantities of IV saline, I added infectious diseases such as a pandemic of some sort. The first known use of IV saline was by Thomas Latta in the 1832 cholera epidemic. [link to bji.sagepub.com] We can use other IV fluids, but these are now also starting to become in short supply as well. [link to www.ashp.org] This letter pertains to Lactated Ringers as well as Normal and half normal saline. [link to www.fda.gov] Last Edited by emerald eye on 06/10/2014 12:28 PM Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| Anonymous Coward User ID: 52862479 United States06/10/2014 01:07 PM Report Abusive Post Report Copyright Violation | Aside from massive govt stockpiling, I think there are manufacturing issues. And by that I mean the world is falling apart Atlas-Shrugged style: nobody knows how to do anything anymore, you've got an illiterate third-world refugee on the production line who gives zero shits about sterility and product formulation. I've had real issues with Baxter Healthcare in particular putting out drugs with contaminants, drugs with the wrong dosage, etc. Companies are shut down frequently over contamination issues. Because we live in a world where nobody cares about doing their job anymore, and the corporations are all too willing to cut corners. Another problem is forced waste. If I have to give a patient a 4mg dose of morphine, it comes in a 10mg vial. I have to destroy the remaining 6mg to comply with DEA and FDA rules. Even though there will be no morphine left for the next patient. If I take a patient into the hospital with a normal saline IV running, many (not all) hospitals will disconnect that bag and throw it away, then start their own bag so they can bill for it. |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 01:23 PM Report Abusive Post Report Copyright Violation | Paramedic here: we can't get normal saline. The story is that they can't get the 1000mL size bags. Why a shortage of plastic bags, I can't imagine. There are also shortages of D-50 (50% Dextrose to treat hypoglycemia, morphine, and Solu-Medrol. Quoting: Locklearish Aside from massive govt stockpiling, I think there are manufacturing issues. And by that I mean the world is falling apart Atlas-Shrugged style: nobody knows how to do anything anymore, you've got an illiterate third-world refugee on the production line who gives zero shits about sterility and product formulation. I've had real issues with Baxter Healthcare in particular putting out drugs with contaminants, drugs with the wrong dosage, etc. Companies are shut down frequently over contamination issues. Because we live in a world where nobody cares about doing their job anymore, and the corporations are all too willing to cut corners. Another problem is forced waste. If I have to give a patient a 4mg dose of morphine, it comes in a 10mg vial. I have to destroy the remaining 6mg to comply with DEA and FDA rules. Even though there will be no morphine left for the next patient. If I take a patient into the hospital with a normal saline IV running, many (not all) hospitals will disconnect that bag and throw it away, then start their own bag so they can bill for it. Thanks for the input, and yes, massive waste by hospitals is part of the design. When we had a huge morphine shortage, and used just essentially a drop or two out of a 10 ml vial for an epidural anesthetic, the rest had to be thrown away, even when it meant that the next patient would get none. It is totally insane, but everyone is afraid to challenge the insanity of the protocols that are already in place to discard anything opened and not used. I fear that in the very near future, if not now, we are needing to re-think all of this. Those hospitals had better start thinking twice about throwing away the portion of unused bag, especially if the patient is going to need that IV fluid. We have take concerns about sterility and turf to the extreme! BTW, thanks for being a paramedic. Love you guys and gals, you are AWESOME!!!  PS. I agree, Baxter sucks. Last Edited by emerald eye on 06/10/2014 01:26 PM Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| Anonymous Coward User ID: 59038558  Hong Kong06/10/2014 01:36 PM Report Abusive Post Report Copyright Violation | |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 01:42 PM Report Abusive Post Report Copyright Violation | |
| I'mpossible
User ID: 59103517 United States06/10/2014 09:04 PM  Report Abusive Post Report Copyright Violation | Thanks for reminding everyone about the glass dispensers. And the sterile saline solution ratios. I'm going to copy it for reference. If you have the ratios for D5W, there are probably a few around who could use it, too. Just for informational purposes, mind you. And historical reference to pre-Industrial Age artifacts. It might be difficult to find old fashioned compounding pharmacists and nurses. Never would have thought those skills had fallen out of favour! Is it even taught in schools now? I don't expect you to answer...just musing. Someone up-thread mentioned IV Heparin being pulled unannounced. Among a couple of other drugs. Drawing a blank right now...dog walking HaHa. One of my concerns is the increase of antibiotic-resistant bacterium strains. C-dif is a literal killer and can spread so quickly... Apocalypse: All shall be revealed. And all shall be revealed. ******* All Human Beings are Human. Not all Humans are Human Beings. ******* |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/10/2014 11:31 PM Report Abusive Post Report Copyright Violation | Thanks for reminding everyone about the glass dispensers. And the sterile saline solution ratios. I'm going to copy it for reference. Quoting: I'mpossible If you have the ratios for D5W, there are probably a few around who could use it, too. Just for informational purposes, mind you. And historical reference to pre-Industrial Age artifacts. It might be difficult to find old fashioned compounding pharmacists and nurses. Never would have thought those skills had fallen out of favour! Is it even taught in schools now? I don't expect you to answer...just musing. Someone up-thread mentioned IV Heparin being pulled unannounced. Among a couple of other drugs. Drawing a blank right now...dog walking HaHa. One of my concerns is the increase of antibiotic-resistant bacterium strains. C-dif is a literal killer and can spread so quickly... C diff can be a killer, and it is generally treated by metronidazole, which is also in short supply now. [link to www.ashp.org] [link to doctors.seton.net] If you want to stock something that would help to protect against and prevent recurrent C diff, I would recommend the probiotic Florastor. "A recent meta-analysis of 31 studies compiled and published in the American Journal of Gastroenterologyconcluded that S. boulardii is the only probiotic that is effective in fighting recurrent C. diff-associated disease1 Additionally, an article in the March 2006 issue of Gastroenterology and Hepatology showed that use of S. boulardii provided an almost 50 percent decrease in subsequent recurrence among patients who suffered recurrent CDAD symptoms.2 "Because Florastor (S. boulardii) is a yeast and not a bacteria, it is not killed by the strong antibiotics that are being used to kill the C. diff bacteria, so it survives in the digestive tract," says Dr. Raymond. "When the 'baby' C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground." [link to www.medicalnewstoday.com] It is a bit pricey, but you can buy it without a prescription. [link to www.costco.com] As to you dextrose question: For a one liter bag, or 1,000 cc the amount of dextrose is 50 grams for a 5% solution or 50/1000=1/20=.05 or 5% "In every bag of dextrose 5%, the gram dosage is approximately 10 times the percent. For example, in a 1 L bag of dextrose 5%, 50 g of dextrose can be found. This is true regardless of the sodium content." [link to www.ask.com] Pharmacists must learn these things in school, (BTW I am not a pharmacist) but I think that many may forget these types of calculations, as they are not often used today. PS. Be very careful about plain D5 in water, as it becomes non-isotopic as the glucose is metabolized, and hypotonic solutions can cause cells to rupture, and can also cause volume shifts such as increased intracranial pressure and cardiovascular collapse when administered in larger volumes. That is why isotonic solutions such as normal saline and ringers lactated are usually preferable for short term large volume replacement. [link to www.resourcenurse.com] [link to rxstudyguidesuic.files.wordpress.com] All the best to you. Last Edited by emerald eye on 06/10/2014 11:45 PM Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| Anonymous Coward User ID: 11121291 United States06/11/2014 12:32 AM Report Abusive Post Report Copyright Violation | Thanks for reminding everyone about the glass dispensers. And the sterile saline solution ratios. I'm going to copy it for reference. Quoting: I'mpossible If you have the ratios for D5W, there are probably a few around who could use it, too. Just for informational purposes, mind you. And historical reference to pre-Industrial Age artifacts. It might be difficult to find old fashioned compounding pharmacists and nurses. Never would have thought those skills had fallen out of favour! Is it even taught in schools now? I don't expect you to answer...just musing. Someone up-thread mentioned IV Heparin being pulled unannounced. Among a couple of other drugs. Drawing a blank right now...dog walking HaHa. One of my concerns is the increase of antibiotic-resistant bacterium strains. C-dif is a literal killer and can spread so quickly... Dextrose is in white Karo syrup. Sodium Lactate for LR is supposedly available from soap maker suppliers KCL from certain water softeners or Salt substitues. I agree with someone early on, they intend to let you die. If you dont stock for yourself you will be left out. Imagine, local anesthesia was near impossible to get. All the supply shortages are those which are most important in the most basic of emergencies. Even fish antibiotics are going up uP UP! There's even a shortage of medical tape! Americans are used to wasting, are forced to waste at the most inopportune times but the time for waste is long gone. You have a target painted on your back and it would behoove you to find out why its there and who put it there. |
| Anonymous Coward User ID: 11121291 United States06/11/2014 12:48 AM Report Abusive Post Report Copyright Violation | I wouldnt be surprised if opthalmalogic surgeons cannot get cocaine solution for their eye surgeries if everyone else surgical cant get morphine. FER KRISSAKES, they catch and DESTROY the basic chemicals pouring over the borders while buying it from elsewhere for big dollars. All this can be purified, and obtained for free, but NooooOOOoooooo! Pay through the nose for it, suckers. Americans are forced to waste time and resources so that a few annointed others can make windfall profits from mandated waste. One case of this is that IV fluids come with stupid expiration dates. Apparently salt water has a need to be thrown out far sooner than it needs to be. ITS FUCKING SALT WATER and sometimes has a SIMPLE CARBOHYDRATE dextrose in it and it can be good for a hundred years if put in the proper container. But why? In that liter of water there is maybe a tablespoons worth of basic simple chemicals, cheap and stable. You probably pay more for the container than the contents. |
| I'mpossible
User ID: 59103517 United States06/11/2014 01:05 AM Report Abusive Post Report Copyright Violation | Thanks Emerald Eyes! It's a shame to hear you cannot draw only what is needed from a sterile vial into a sterile vial for dispensing. The remainder needs to be destroyed... In clinical setting does this included insulin? Genuinely curious. Have to keep my ears up regarding shortages, especially for Vets. They're usually hit first as animals are expendable. Please don't think I'm negating animals. It's just a fact of life. If the person needs LR or the dog needs LR, what choice is there ethically... Apocalypse: All shall be revealed. And all shall be revealed. ******* All Human Beings are Human. Not all Humans are Human Beings. ******* |
| emerald eye
(OP) Keeping an "eye out" for the truth. User ID: 57762252 United States06/11/2014 01:32 AM Report Abusive Post Report Copyright Violation | Yes, there is massive waste built into protocols that were originally intended to preserve sterility and eliminate any possibility for cross contamination. While the intent was good, things in my opinion anyway, have gone way overboard. Even inserting a sterile needle into a vial necessitates that the entire vial be discarded unless it was intended as a multi-dose vial (Influenza shots) with a poisonous preservative in it like Thimerosal (Mercury) . But that is a whole other discussion, and I did a thread on that a while back. And you are correct, the ingredients are cheap, cheap, cheap. The cost and the difficulty is making them sterile enough to be safe to put into someone's vein. Mere boiling is not sufficient to destroy some of the bacterial spores, such as clostridia, all equipment must be autoclaved. You must also compound this in an area with sufficient air purity maintained by a HEPA-filter and a buffer area between it and the regular environment. And of course, this is also regulated by State and Federal law. This will give you an idea of the complexity and the regulations that are required to meet current standards. [link to www.ashp.org] Courage forges a path through all obstacles, while fear is the obstruction of all dreams. The only way that anyone gets something for nothing, is that someone else has given up something for nothing. |
| Anonymous Coward User ID: 11121291 United States06/14/2014 09:20 AM Report Abusive Post Report Copyright Violation | Yes, there is massive waste built into protocols that were originally intended to preserve sterility and eliminate any possibility for cross contamination. While the intent was good, things in my opinion anyway, have gone way overboard. Even inserting a sterile needle into a vial necessitates that the entire vial be discarded unless it was intended as a multi-dose vial (Influenza shots) with a poisonous preservative in it like Thimerosal (Mercury) . But that is a whole other discussion, and I did a thread on that a while back. Quoting: emerald eye And you are correct, the ingredients are cheap, cheap, cheap. The cost and the difficulty is making them sterile enough to be safe to put into someone's vein. Mere boiling is not sufficient to destroy some of the bacterial spores, such as clostridia, all equipment must be autoclaved. You must also compound this in an area with sufficient air purity maintained by a HEPA-filter and a buffer area between it and the regular environment. And of course, this is also regulated by State and Federal law. This will give you an idea of the complexity and the regulations that are required to meet current standards. [link to www.ashp.org] The filtration aspect is overblown, addicts inject all manner of shit and it takes a long time to get SBE. For commando medics a pressure cooker is a tolerable substitute for a sterilizer. I wouldn't recommend making fluids for storage but basic customised fluid replacement is possible by the resourceful, prepared person can make do and stretch resources for relatively little money. There is one reason for creating a situation of centralized control and thats so they can cut it off when desired. They intend to cull the population (of gentiles) its even been chiseled in stone, not to mention there is a whole book about it thats been revered by them for 3000 years or so. before the disposables came along things were used over and over. |
| Anonymous Coward User ID: 31496863  Canada06/14/2014 09:52 AM Report Abusive Post Report Copyright Violation | |
| Anonymous Coward User ID: 11121291 United States06/14/2014 10:29 AM Report Abusive Post Report Copyright Violation | its sterilized salt water,why cant you make it yourself?????????????can people not hink anymore Quoting: Anonymous Coward 31496863 Its about liability and centralised control. It would be a simple affair to mechanise an automated system and make anything you want for pennies locally on demand. Yes its just a few grams of salt, sugar and additives. Its about central oligarch control of the consumer public to let them live for the right price or to leave them die whenever desired. |
| zacksavage
User ID: 54508129 United States06/14/2014 10:53 AM Report Abusive Post Report Copyright Violation | |
| Anonymous Coward User ID: 59069847 United States06/14/2014 11:09 AM Report Abusive Post Report Copyright Violation | The gumment is buying it all up! They know something we don't. I think that is a sign that the end is near. If you don't have your preps together, you don't have much time. 5* Quoting: Epic Beard Guy Yes, the government has "tampered" to create this problem, there is no other rational explanation. This was supposed to have gotten better months ago, and it has only gotten progressively worse. The question now is why? Even if you don't think you will need surgery, a hospital, or even a clinic visit involving IV fluids, this could affect you because of the possible reasons behind it. “A lot of variables came together to create this,” said Scott Crandall, director of medical supply contracts at Novation, a group buying organization in Texas that manages contracts for SF General and 2,000 other hospitals across the country. He’s been hearing from manufacturers that increased FDA scrutiny is interfering with drug production." “I called up a clinical person that I knew, at like 11:30 at night and said, ‘Well, what happens if we run out of saline?’ Because I was really afraid,” he remembers. “And they were just like, ‘Yeah, it gets ugly, fast.’” [link to blogs.kqed.org] Unlike a lot of GLP fantasy threads (some of which I really enjoy), this is real information from the real world. Heads up people! Obamacare at work |
| Anonymous Coward User ID: 776811 United States06/14/2014 11:48 AM Report Abusive Post Report Copyright Violation | [link to www.fda.gov] [04/28/2014] In response to the ongoing shortage of 0.9% sodium chloride injection1 (normal saline),Baxter Healthcare Corp.2 of Deerfield, Ill., will temporarily distribute normal saline in the United States from its Spain manufacturing facility. FDA is temporarily exercising its discretion regarding the distribution of Baxter’s saline product from Spain and Fresenius Kabi’s saline product from Norway as needed to address this critical shortage, which poses a serious threat to patients |
| beeches
User ID: 28167778 United States06/14/2014 12:25 PM  Report Abusive Post Report Copyright Violation | It must contain some banned words, but for the life of me, I can't figure out why it won't post and after making several revisions, I still can't get it to post. Quoting: emerald eye sometimes that happens. Great thread. Scary as all get out, though. Liberalism is totalitarianism with a human face – Thomas Sowell |
| beeches
User ID: 28167778 United States06/14/2014 04:50 PM Report Abusive Post Report Copyright Violation | |
| beeches
User ID: 28167778 United States06/14/2014 04:52 PM Report Abusive Post Report Copyright Violation | |
| Anonymous Coward User ID: 42067627 United States06/14/2014 05:06 PM Report Abusive Post Report Copyright Violation | |
| Anonymous Coward User ID: 43658232 United States06/14/2014 05:08 PM Report Abusive Post Report Copyright Violation | Paramedic here: we can't get normal saline. The story is that they can't get the 1000mL size bags. Why a shortage of plastic bags, I can't imagine. There are also shortages of D-50 (50% Dextrose to treat hypoglycemia, morphine, and Solu-Medrol. Quoting: Locklearish Aside from massive govt stockpiling, I think there are manufacturing issues. And by that I mean the world is falling apart Atlas-Shrugged style: nobody knows how to do anything anymore, you've got an illiterate third-world refugee on the production line who gives zero shits about sterility and product formulation. I've had real issues with Baxter Healthcare in particular putting out drugs with contaminants, drugs with the wrong dosage, etc. Companies are shut down frequently over contamination issues. Because we live in a world where nobody cares about doing their job anymore, and the corporations are all too willing to cut corners. Another problem is forced waste. If I have to give a patient a 4mg dose of morphine, it comes in a 10mg vial. I have to destroy the remaining 6mg to comply with DEA and FDA rules. Even though there will be no morphine left for the next patient. If I take a patient into the hospital with a normal saline IV running, many (not all) hospitals will disconnect that bag and throw it away, then start their own bag so they can bill for it. I can help you comply with the Feds ;) Good reply Locklearish and Good thread, Emerald. Yes, everyone...stay safe this Summer and don't do anything stupid... Some lady in Houston (I believe) cleaned her grill with a wire brush. Perhaps it was old or cheap, but a few wires were left on the grill and stuck to the food. She swallowed it and it perforated her intestine!!! |
| Anonymous Coward User ID: 11121291 United States06/14/2014 05:39 PM Report Abusive Post Report Copyright Violation | Besides simple steam and pressure sterilization there is also microwave applications. Does anyone know anything about newer non nuclear methods for sterilization under nonstandard conditions? The world didn't start with nice prepared disposable systems. There used to be glass syringes, rubber tubing and needles that were cleaned and reused. Somehow, other than when dealing with CJD, people survived. I don't care about what happens to someones foofoo bright cosy plastic surgery clinic currently, I care about taking care of things when that nice clinic is nothing but a cold, dark shattered ruin. |
| Anonymous Coward User ID: 6066319 United States06/14/2014 05:54 PM Report Abusive Post Report Copyright Violation | |
| idunno User ID: 7026093 United States06/14/2014 06:27 PM Report Abusive Post Report Copyright Violation | This is seriously bad. My sister has kidney disease, and she just told me her supplier for at home kidney dialysis bags has a shortage. She is supposed to do dialysis at home everyday. They aren't sending her more for a week! I am so worried something bad is gonna happen :( |
| idunno User ID: 7026093 United States06/14/2014 06:29 PM Report Abusive Post Report Copyright Violation | This is seriously bad. My sister has kidney disease, and she just told me her supplier for at home kidney dialysis bags has a shortage. She is supposed to do dialysis at home everyday. Quoting: idunno 7026093 They aren't sending her more for a week! I am so worried something bad is gonna happen :( Forgot to mention Baxter is the company shorting my sick sister... :( |
