Emergency medical services facing critical shortage of dextrose


Amid shortages stretching back months to more than a year of dextrose syringes and intravenous fluid bags to treat a wide variety of emergency conditions, America’s emergency medical services (EMS) are scrambling to adapt the treatment protocols and organize training on how to use them.

According to David Margraf, PharmD, PhD, pharmaceutical researcher at the Resilient Drug Supply Project (RDSP), part of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, publisher of CIDRAP News

While oral glucose could replace dextrose injections, Margraf said, “there will be many patients who cannot take anything by mouth, so they need intravenous or intraosseous dextrose. The other option is intramuscular or intranasal glucagon, but this drug is expensive. , in short supply, and may not be the appropriate treatment for some patients.”

Glucagon also has the disadvantages of having a slower onset of action and being more difficult to administer than dextrose. “Prefilled dextrose syringes are preferred, but emergency medical services often use dextrose from big bags,” Margraf said. “It adds time and complexity.”

And because stocks of glucagon, a hormone that stimulates the production and release of glucose, have not been shipped for over 6 months and are out of stock, many EMS agencies no longer even include it in their treatment protocols, according to EMS1.

Some products out of stock until 2023

According to the U.S. Food and Drug Administration (FDA), dextrose formulations in short supply include 25% Dextrose Injection (manufacturer Hospira/Pfizer, reported February 2022) and 50% Dextrose Injection ( Amphastar Pharmaceuticals and Hospira, January 2022). The American Society of Health-System Pharmacists (ASHP) reports the same shortages, with the addition of a large-volume 70% dextrose injection (B. Braun Medical and ICU Medical, July 2022).

While B. Braun, Baxter Healthcare, Fresenius Kabi, and ICU Medical are reporting back orders or very limited quantities of 5% Dextrose Injection and 10% Dextrose Injection in small volume (for which demand was historically low), and Pfizer is reporting limited quantities of 25% dextrose, supply is expected to significantly exceed demand in the fall. The reasons given by the manufacturers are either “increased demand for the drug” or “other”.

In a March 4, 2022 letter to emergency syringe customers, for example, Pfizer attributed the product shortages to “a complex combination of factors, including significant and sustained increases in demand for products in our portfolio, in largely due to competitor shortages as well as other COVID-19 related impacts and isolated manufacturing delays, many of which have now been resolved.While Pfizer has worked to meet this increased demand, which is well higher than historical volumes, market needs continue to exceed Pfizer’s production capacity.

In the letter, Pfizer had estimated that its 25% dextrose formulation would be back in stock in June 2022 (although as of August 4, 2022 it remains in short supply) but that the 50% product is not expected before January 2023.

While the FDA is aware of the dextrose and glucagon shortages, EMS1 reports that the likelihood of manufacturing capacity to produce these products anytime soon is very low. “And if the products are made in a site prone to tropical weather, there is always the risk that the shortage will worsen further, as happened in 2017,” the article said.

Downstream impact, cost increase

Stephen Schondelmeyer, PharmD, PhD, co-principal investigator for RDSP, said dextrose is a cornerstone among EMS supplies.

“Recent dextrose shortages are having a huge impact on virtually every firefighter, paramedic, and EMS tech in the country,” he said. “Emergency kits need to be adapted to include different forms of dextrose or alternative products that are currently available. This change is no small feat, as treatment protocols need to be reviewed and updated, and new training may be necessary.”

New sources for these alternative products must be identified and stock levels established and maintained, according to Schondelmeyer. “Collaboration between health systems and regional distributors is necessary to effectively acquire alternative supplies,” he said. “All of these adjustments are triggered by the dextrose shortage and add more cost and complexity to emergency medical systems.”

“The shortage of dextrose solutions provides another illustration of the profound cascading impact of market and downstream supply chain failures for essential medicines,” Schondelmeyer added.


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