If you have ever had general surgery, chances are you would have been administered intravenous (IV) fluids.
A global shortage of multiple IV fluid products has prompted Australian health authorities to conserve their stock levels in hospitals, while veterinary clinics across the country are already grappling with shortages.
What is saline used for?
Sodium chloride — salt, commonly known as saline in solution — and sodium lactate solutions are some of the fluids in short supply worldwide.
IV fluids are used to treat common medical conditions or mixed with other medications.
They are particularly vital when treating sepsis and dehydration, and are used during resuscitation, post-anaesthesia care and intensive care.
Federal Assistant Minister for Health Ged Kearney described saline as "one of the go-to fluids" and "an essential part of care" in Australia's health system.
What's causing the shortage?
The Therapeutic Goods Association (TGA) says "manufacturing issues and unexpected increases in demand" are to blame for the saline and fluids shortage.
There are three "sponsors" registered with the TGA to import, export or make the affected IV fluids.
A spokesperson from one of these sponsors, Baxter Healthcare, said it had been experiencing "a notable increase in demand for sterile fluid products in Australia as a result of multiple external factors, including increased customer demand and constrained supply, due in part to outages from other suppliers".
Baxter Healthcare did not respond to questions from the ABC about the source of this increased demand for IV fluids, or where the outages were occurring in the supply chain.
How will I be affected?
The Baxter Healthcare spokesperson said they were "prioritising supply continuity for hospitals".
Royal Australasian College of Physicians president Professor Jennifer Martin called the fluids shortage "a big problem" due to the vital nature of the fluids and the uncertainty around when the shortage would end.
The clinical pharmacologist said there were various ways the federal and state governments, health authorities and healthcare workers were coping with supply issues.
Professor Martin said most hospital patients would not be aware of the shortage, as healthcare workers could use other methods to deliver many medications, such as the "slow push" into an intravenous injection and oral intake.
"Sometimes we do use IV fluids to give medicines, and that's probably not essential, but it does help our workflow because it enables us to dilute our medicine and then get on with other jobs for the patient," Professor Martin said.
"We're asking people just to use [IV fluids] where it's absolutely needed."
It's not just humans
Animals of all shapes and sizes are administered IV fluids by veterinarians in small animal clinics, animal production practices and equine practices.
The fluids help animals maintain blood volume while under general anaesthesia, in serious surgeries and after traumas such as car accidents.
Australian Veterinary Association president Dr Sally Colgan said the shortage had been "very concerning" for vets, who had been facing supply issues in clinics.
"We are definitely seeing problems already, what we are seeing is a shortage of the routine types of fluids that our practices are using," she said.
Dr Colgan said small animals might only need half a litre to a litre of IV fluids, but a horse may need 3 to 5 litres a day to maintain blood volume.
For vets who are already grappling with workforce shortages, the shortage of these critical fluids is an added stress.
"It's important our clients realise that vets are facing this stress and they are doing everything they can to make sure that your pet or your animal gets the best possible care, but these are challenging times for us," Dr Colgan said.
Did authorities expect this shortage?
Health and veterinary authorities in Australia have been releasing directions to manage the shortage of fluids since June.
A spokesperson for the Tasmanian Department of Health said it raised concerns with the TGA more than 18 months ago.
What's being done?
The TGA has approved the importation of alternative, overseas-registered saline fluids to address the shortage and is considering other steps, if required.
In an email seen by the ABC, SA Ambulance Service banned the use of saline in training scenarios and advised paramedics to use the solution "judiciously" to reduce wastage.
Health authorities in SA and NSW have directed staff to review and preserve stock levels.
The Tasmanian Department of Health and Statewide Hospital Pharmacy have formed a partnership to create a "small buffer of stock" of the fluids, while the department is still pushing for federal involvement.
"Given the potential implications for the delivery of hospital services, the department continues to advocate for the issue to be addressed at a national level," a Tasmanian Department of Health spokesperson said.
Queensland Health has formed a working group to ensure continual supply across the state but a spokesperson did not detail what measures have been taken.
An ACT government spokesperson said its Health Directorate had been working with other health services to provide regular updates and share stock as required.
"Canberra Health Services has processes in place to manage purchasing of stock, movement of stock and daily review of usage of intravenous fluid," the spokesperson said.
An NT Health spokesperson said it was aware of the ongoing supply disruption but there had been no direct impact to their hospitals yet.
Dr Colgan said the association had directed vets to reconsider their usage of IV fluids, as well as working with the Australian Pesticides and Veterinary Medicines Authority — the animal equivalent of the TGA — to get overseas fluids distributed here.
When will supply be back to normal?
A TGA spokesperson said supplies of IV drugs were likely to be "constrained" for the rest of the year, while a NSW Health spokesperson said normal supply was expected to resume over the coming months.
The shortage has put the issue of Australian manufacturing of medicine back in the spotlight.
Australian Medical Association president Professor Steve Robson said the federal government had made efforts in recent years to address medicine shortages, yet they remained "a serious problem".
"The TGA is doing a good job coordinating responses to serious shortages, but what's missing is a comprehensive strategy to ensure medicines supply at all stages of the pipeline," he said.
Professor Martin said global manufacturing issues were felt more acutely in Australia and New Zealand.
"We're the end of the supply chain for a lot of these agents and we don't have a backup manufacturing capability for a lot of the medicines and IV fluids that we use across Australia and New Zealand," she said.
