A shortage of IV fluid is forcing hospitals across the country to conserve and even postpone surgeries and procedures after an IV fluid production facility in North Carolina was hit by the devastating floods from Hurricane Helene.

The Baxter International plant in North Carolina didn’t just make IV fluid — it made roughly two-thirds of all the IV fluid in the country, according to Dr. Chris DeRienzo, senior vice president and chief physician executive of the American Hospital Association.

“And a product like IV fluids is almost like having water to your house — you need tons, like literal tons of this fluid in America’s largest hospitals every day,” he said.

The short supply of fluids has had a ripple effect nationwide, in some cases prompting postponed procedures.

“We’ve seen these conservation efforts begin, and they’re now taking root from coast to coast and border to border,” DeRienzo said.

Making IV fluid is a little more complex than mixing salt and water – or making masks during a pandemic.

“We saw companies transition over to making PPE, which is a much easier transition for companies to make masks and gloves and gowns than it is to make IV fluids that need to be sterile and have specific — for lack of a better word — recipes,” explained Dr. Lauren Sorce, who is with the Society of Critical Care Medicine and works at a hospital in Chicago.

While hospitals are having difficult conversations about who gets access to limited IV fluids with vulnerable critical care patients, there’s no ruling out fatal consequences.

“If hospitals cannot get their hands on IV fluids to mix the important drugs that need to be given, then I would imagine that there would be the potential for that,” Sorce said

So, if IV fluids are so critical, why is this supply chain so fragile in the first place?

“Health care is traditionally very price-focused,” noted Rob Handfield, a professor of supply chain management at North Carolina State University. “If the margins are very low, not a lot of people want to go into that business.”

Because it’s not very profitable, Handfield said there are few U.S. producers. Plus, IV fluids aren’t easy to import.

“They’re heavy, they’re bulky, and they don’t cost a lot,” he said, “so you tend to produce them in the same country where they require those bags and where they’re being distributed.”

The North Carolina plant will likely take months to get up and running. For now, the government is taking emergency measures to back-fill the broken supply chain — including temporary permission from the FDA to import IV fluids from factories abroad.