Why Do IV Fluid Shortages Keep Happening? Three Companies, One Hurricane, No Slack
Why do IV fluid shortages keep happening? Because nearly all IV solutions in the US market are made by three companies, the product sells for very little despite costing a great deal to make safely, and a single flooded plant can take out 60 percent of national supply. The 2024 saline shortage is the clearest example: Hurricane Helene damaged Baxter's North Cove, North Carolina facility, and hospitals across the country started rationing salt water within weeks.
Salt water. That is the part people cannot get past, and honestly it is the right reaction. Sodium chloride 0.9 percent is about as simple a product as medicine makes. But simple to describe is not simple to manufacture. Making a sterile IV solution takes roughly three weeks and more than 30 steps, under FDA oversight at every stage, because anything injected into a vein must be absolutely sterile. The chemistry is trivial. The sterility is the whole job, and sterility does not scale on short notice.
The concentration problem
Three companies make nearly all US IV solutions: Baxter, B. Braun, and ICU Medical. Baxter's North Cove plant alone produced about 60 percent of the IV fluids used in the United States before Helene. When one plant is three fifths of supply, there is no "other supplier" to switch to. Distributors allocate, hospitals conserve, and elective surgeries get postponed, which is exactly what happened in late 2024. Becker's Hospital Review documented health systems moving to conservation protocols and alternative hydration fluids, keeping surgery running at reduced capacity at the cost of efficiency and workflow familiarity.
The reason there are only three is economics, not technology. IV fluids are regulated as pharmaceutical products, with the full capital cost of sterile injectable manufacturing, but sold at low prices. Raw material and plastic costs have crept up over twenty years while regulatory and quality maintenance costs have risen several fold. Margins are thin, new entrants face enormous startup costs and FDA qualification, and existing manufacturers have little incentive to build spare capacity that sits idle in good years. The market, left alone, converges on a few big plants running near capacity. That is efficient until it is not.
Why the shortage ended, and why the next one is already baked in
The FDA eventually declared the sodium chloride 0.9 percent shortage resolved, after close work with manufacturers and the Administration for Strategic Preparedness and Response: expedited production scale ups, temporary importation of IV solutions from facilities abroad, and extended expiry dating to stretch existing stock. Baxter's North Cove plant returned to pre hurricane production levels, and allocations were removed for virtually all IV solution product codes made there.
But read the resolution carefully. The FDA statement covered IV saline specifically. The ASHP senior director for pharmacy practice cautioned at the time that other sterile product shortages persisted: electrolytes, dextrose based fluids, and specialty formulations. The system that produced the shortage did not change. Production is still concentrated, margins are still thin, and the next disruption, a hurricane, a contamination shutdown, a quality halt at a major facility, hits the same unbuffered supply chain. Hospitals were urged after the crisis to set up dual source agreements for tier one consumables, which is an admission that the buffer has to be built by buyers, because manufacturers will not build it themselves.
For patients, the practical takeaway is less dramatic than the headlines but worth knowing. If your surgery or infusion is delayed during a shortage, it is usually a supply allocation problem, not a problem with your care team, and asking your hospital whether a conservation protocol or an alternative fluid applies to your case is a reasonable question. For everyone else, the same pattern shows up anywhere a cheap, sterile product is made in three places: a storm in one county becomes a national shortage. Check current shortage listings in the tracker here, and treat any listing for a fluid your care depends on as an early warning, not a headline.
Frequently asked questions
Why is there a shortage of something as simple as saline?
Because sterile manufacturing is the hard part, not the chemistry. A batch takes about three weeks and more than 30 steps under strict FDA oversight. When production is concentrated in a few plants, one disruption removes a large share of national supply, and no new supplier can spin up sterile capacity quickly.
How much of US IV fluid supply did Baxter's North Cove plant make?
About 60 percent of the IV fluids used in the United States, before Hurricane Helene damaged the facility in 2024. That concentration is why the shortage spread nationally within weeks.
Is the IV saline shortage over?
The FDA declared the sodium chloride 0.9 percent injection shortage resolved after Baxter restored production and temporary imports filled the gap. Other sterile fluid shortages, including electrolytes and dextrose based fluids, persisted beyond that announcement.
Can hospitals just switch to a different IV fluid during a shortage?
Not freely. IV fluids differ in salt, sugar, and other components, and the body's cells respond to those concentrations through osmosis. Switching fluids changes what happens inside the bloodstream, so substitutes need clinical protocols, not just a purchasing decision.
Why don't more companies make IV fluids?
Because the economics discourage it. Sterile injectable manufacturing carries high capital and regulatory costs, while IV fluids sell at low prices. Thin margins plus heavy qualification requirements mean few entrants and little spare capacity.
Related reading: How Hospitals Manage Drug Shortages · Why Are Generic Drugs in Shortage in 2026? The Economics, Explained · How to Check the FDA Drug Shortage List · How Long Do Drug Shortages Last?
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