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Hospitals around the country are conserving critical intravenous fluid supplies to cope with a shortage that may last months. Some hospital administrators say they are changing how they think about IV fluid hydration altogether.

This story also ran on NPR. It can be republished for free.

Hurricane Helene, which hit North Carolina in September, wrecked a Baxter International facility that produces 60% of the IV fluids used in the U.S., according to the American Hospital Association.

The company was forced to stop production and is rationing its products. In an update posted Nov. 7, Baxter said its North Cove facility had resumed producing some IV fluids. In an email to KFF Health News, the company wrote that customers will be able to order normal quantities of certain IV solutions products by the end of the year, but there is no timeline for when the North Cove facility will be back to prehurricane production levels.

Meanwhile, hospitals are facing seasonal strains on their already limited IV fluid resources, said Sam Elgawly, chief of resource stewardship at Inova, a health system in the Washington, D.C., area.

Weve been very aggressive in our conservation measures, Elgawly said, stressing that he does not believe patient care has been compromised. He told KFF Health News that across the system IV fluid usage has dropped 55% since early October.

Elgawly called the shortage a crisis that he expects to have to continue managing for some time. We are going to operate under the assumption that this is going to be the way it is through the end of 2024 and have adopted our demand/conservation measures accordingly, he said. Email Sign-Up

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At the end of the calendar year, many patients with insurance hurry to schedule surgical procedures before their deductibles reset in January. Elgawly is eyeing that typical surgical rush and the impending peak of respiratory virus season as he tries to stockpile IV fluid bags. Hospitals such as Inovas are using different ways to conserve, such as giving some medications intravenously, but without a dedicated IV fluid bag, known as a push medication.

You don’t even need a bag at all. You just give the medication without the bag, he said. There has been increasing literature over the last 10 to 20 years that indicates maybe you don’t need to use as much. And this accelerated our sort of innovation and testing of that idea.

Monica Coleman is a nurse at a Department of Veterans Affairs hospital in North Chicago. She said using push medications takes more time out of a nurses already hectic schedule because then they need to monitor the patient.

This could increase adverse effects within the patient, because we’re giving the medication at a faster rate, she said.

Elgawly is also interested in retooling electronic health records to question doctor orders for more IV hydration.

Does the patient actually need that second bag? How did they do today with eating or drinking water or juice? They did well? They don’t need the bag. So it’s little conservation mechanisms like that that, when you add them across, you know, the 2,000-patient system that Inova is, make a significant dent, he said.

Simpler conservation measures could become common after the shortage abates, said Vince Green, chief medical officer for Pipeline Health, a small hospital system in the Los Angeles area that serves mainly people on Medicare and Medicaid.

First, Green would like to see data showing that patient outcomes arent affected. But for now, some of the new strategies just make sense to him. He has directed hospital staff to use up the entire IV bag before starting another.

If they come in with IV fluids that the paramedics have started, lets continue it. If it saves half a bag of fluids, so be it, but it adds up over time, he said.

Patients may be asked to take more accountability for their hydration, by drinking Gatorade or water rather than the default of hydrating through an IV, he said.

From an environmental aspect, we don’t need to have this much waste and fill up our landfills. If we could reduce stuff, I think it’d be wise, he said.

But hell feel better when his hospitals receive a full order, which could be weeks away. Green said they are down to a two-week supply, with an expected increase in hospitalizations due to respiratory virus season.

We’re purchasing every IV fluid bag that we can get, he said.

Jackie Fortir: @JackieFortier Related Topics Health Industry States Hospitals North Carolina Contact Us Submit a Story Tip

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M’s star Raleigh caps torrid series with 31st HR

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M's star Raleigh caps torrid series with 31st HR

CHICAGO — There is no stopping Cal Raleigh at the moment.

Raleigh has a major-league-leading 31 homers after he helped the Seattle Mariners take two of three against the Chicago Cubs over the weekend. The switch-hitter went deep four times and drove in six runs in the series.

“Just trying to have good at-bats, really,” Raleigh said. “Trying to stay consistent. Really just trying to home in on my approach and not worry too much about what the pitcher is trying to do to me.”

Raleigh had two hits, walked twice and scored three runs in Seattle’s 14-6 victory Sunday. He is batting .327 (37-for-113) with 16 homers and 34 RBIs in his past 29 games.

Raleigh was the designated hitter for the series finale after being behind the plate Saturday. He hammered the first pitch of his at-bat against Colin Rea — a 93.8 mph fastball — for a two-run shot in the top of the first on a hot afternoon at Wrigley Field. The massive drive to center had an exit velocity of 105 mph.

The DH walked in the third and singled and scored in the fifth. After popping out softly for the final out of the sixth, he walked again in the eighth and scored on Randy Arozarena‘s two-run double.

“Thirty-one home runs, he just continues to march through history here,” Mariners manager Dan Wilson said. “It’s fun to watch. … He’s a smart player, so later in the game, not getting too anxious, not trying to out of the zone, not trying to get away from his identity as a hitter and who he is. Just staying right where he needs to stay.”

The 28-year-old Raleigh, who agreed to a $105 million, six-year contract with Seattle in March, is the first switch-hitter to mash at least 30 homers before the All-Star break. He needs four more homers to match Ken Griffey Jr. for the most before the break in Mariners history.

“I think a lot of people don’t watch to pitch to him, and then if you do and fall behind, he hits a lot of homers, obviously,” Seattle pitcher Logan Gilbert said. “He can beat you in a lot of different ways, and it seems like he’s doing it every game, too.”

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Shoeless Jazz: Yanks star loses both cleats, scores

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Shoeless Jazz: Yanks star loses both cleats, scores

NEW YORK — Shoeless Jazz crossed the plate, a century after Shoeless Joe.

Both of Jazz Chisholm Jr.‘s cleats flew off his feet as he scored from second base in the New York Yankees‘ 4-2 win over the Baltimore Orioles in an unusual morning start Sunday.

“I was so sweaty. My socks were wet. Everything had just slipped straight out,” he said.

Chisholm doubled twice, including a go-ahead, two-run drive off the right-center-field wall in the eighth inning, then slid into catcher Gary Sánchez for the final run as New York put the shoe on the other foot, so to speak. The AL East-leading Yankees won their second straight after losing seven of eight in a game that will be remembered for Chisholm’s size 10½ Jordan 1 spikes.

Shoeless Joe supposedly was given his nickname on June 6, 1908, playing semipro ball for the independent Greenville Spinners against the Anderson Electricians. New cleats had caused blisters, and he took them off and hit a long home run in the seventh inning.

Jackson won a World Series title with the Chicago White Sox in 1917, then was among eight players on the so-called “Black Sox” who were banned for life after they were accused of intentionally losing the 1919 Series to Cincinnati in exchange for money from gamblers. He finished with a .356 average in 13 major league seasons.

Asked whether he should be called Shoeless Jazz, Chisholm responded: “Wow. Is that how Shoeless Joe got his name? He ran out of his shoe?” When told Jackson earned the nickname in the 1910s, Chisholm quipped: “Oh, so he wasn’t wearing shoes.”

“I saw a lot of firsts,” Yankees captain Aaron Judge said. “11:30 game to a guy losing both his shoes. I’ve seen one cleat kind of running but not both like that. That was awesome.”

Chisholm is hitting .350 (21-for-60) with 11 RBIs since returning from a strained right oblique that caused him to miss 28 games. He raised his average to .242.

“That’s what I live for. That’s how I grew up playing baseball in high school, little league,” he said. “I don’t feel like it’s no need to change.”

New York trailed 2-0 when Chisholm hit a two-out double off Dean Kremer and headed for home on DJ LeMahieu‘s single to left.

“They say he’s the best shoe tier. I didn’t understand it until he actually did. It took me like a minute to take off my shoes just now.”

Jazz Chisholm Jr. on asking rookie Jasson Domínguez to tie his laces after putting on fresh socks and his spikes

Chisholm’s left shoe popped off between third and home. Seeing rookie catcher Maverick Handley move to his left for Colton Cowser‘s throw up the third-base line, Chisholm tried to veer to avoid contact. He caught the catcher with his right arm as Cowser was spun to the ground and the ball popped out of his mitt. Chisholm fell past the plate as the right shoe was jarred off and from his knees slapped a hand across the plate.

“He had dirt all over his face when I walked out there to get him. Looked like glitter on his face,” Yankees manager Aaron Boone said. “We were all kind of screaming.”

After he reached the dugout, Chisholm stretched out with his stockinged feet on the bench. He put on a fresh pair of socks and then his spikes, and Chisholm asked rookie Jasson Domínguez to tie the laces.

“They say he’s the best shoe tier,” Chisholm recalled in the postgame clubhouse. “I didn’t understand it until he actually did. It took me like a minute to take off my shoes just now.”

Baltimore led 2-1 in the eighth when Ben Rice singled leading off against Bryan Baker for his third hit. Giancarlo Stanton singled to put runners at the corners, and Paul Goldschmidt pinch ran for his fellow former MVP — the first pinch-running appearance of Goldschmidt’s big league career, according to the Elias Sports Bureau.

Baker fell behind 3-0 in the count and left a belt-high fastball over the plate. Chisholm drove it 384 feet off the middle of the wall.

“I wasn’t going to swing if it wasn’t a fastball,” he said.

Goldschmidt, 37, slid in just ahead of Sánchez’s tag. Chisholm was a minor leaguer in Arizona’s system when Goldschmidt starred for the Diamondbacks.

“He was the guy that everybody really watched doing baserunning,” Chisholm said. “Even when I got to Miami, he was still the blueprint of how to run the bases.”

Goldschmidt took pride in his baserunning.

“It’s something that wasn’t secondary behind hitting and defense,” he said.

Chisholm took third on the throw and LeMahieu followed with a chopper to shortstop Gunnar Henderson, who threw home. Chisholm slid headfirst and was at first called out by umpire Jansen Visconti, who didn’t realize Sánchez dropped the ball as he applied the tag.

His first run, however, was the one that will live on in replays for the flying footwear.

“Go out there. Keep playing like that,” Stanton had told him. “You don’t need them.”

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Mets demote struggling catcher Alvarez to minors

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Mets demote struggling catcher Alvarez to minors

The New York Mets have demoted struggling catcher Francisco Alvarez to Triple-A Syracuse, the team announced Sunday.

Catcher Hayden Senger was promoted to the majors in a corresponding move to become the backup to now-primary catcher Luis Torrens.

The moves come after Alvarez went 2-for-5 with a home run in the Mets’ 11-4 Saturday night victory over the Philadelphia Phillies, which snapped New York’s seven-game losing streak.

Alvarez, however, has struggled at the plate this season, hitting .236 with three home runs and 11 RBIs in 35 games. He has an OPS of .652 with 38 strikeouts.

Alvarez, 23, was baseball’s No. 1 prospect in 2022 and hit 25 home runs as a rookie in 2023. In parts of four seasons with the Mets since debuting in 2022, Alvarez is a .223 hitter with 40 homers and 122 RBIs in 263 games.

Senger, 28, made his major league debut this season with the Mets, appearing in 13 games and hitting .179 in 28 at-bats.

The Mets (46-31) enter Sunday night’s game against the Phillies (46-31) tied for first place in the National League East standings.

Field Level Media contributed to this report.

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