Clinical Outcomes Associated With Intravenous Fluid Shortages in Emergency Department Patients: A Propensity Score Matched Cohort Study
Milan Patel, Ahmed M. Afifi, Gabriel G. Bonassi, Ali A. Fakih, Mohamad Moussa, Stephen GriderBackground
Intravenous (IV) saline is critical for emergency department (ED) care, supporting resuscitation, rehydration, and electrolyte correction. National IV fluid shortages, including the shortage following Hurricane Helene in September 2024, may disrupt timely care, yet large-scale evidence on associated clinical outcomes is limited.
Methods
In this retrospective observational cohort study using the TriNetX global federated electronic health record network, adult ED patients aged 18-65 years presenting during a nationwide IV fluid shortage (October 2024-May 2025) were compared with those presenting during a prior period of adequate supply. Cohorts were propensity score matched on demographics and comorbidities. Time-to-event outcomes within 7 days were analyzed using Cox proportional hazards models.
Results
After matching, 2,767,318 patients were included in each cohort. Compared with the non-shortage period, ED visits during the shortage were associated with small but consistent increases in rates of sepsis (HR 1.066), gastroenteritis (HR 1.151), acute kidney failure (HR 1.006), and hyponatremia (HR 1.074). Fluid administration was reduced (HR 0.869), consistent with expectations during the shortage period. Hospitalization (HR 1.06) was more frequent, while mortality did not differ.
Conclusion
Nationwide IV fluid shortages were associated with mild increases in acute complications and healthcare utilization among ED patients without increased short-term mortality. These findings underscore the need for preparedness strategies to mitigate the clinical impact of future IV fluid supply disruptions. Effect sizes were modest, and while statistically significant, they likely represent small individual level clinical differences. Given the large number of ED encounters affected, these patterns may reflect broader health-system strain during the nationwide shortage.