Parenteral Nutrition Component Shortages Update

The number of new drug shortages, including shortages of sterile injectable drugs, has decreased.  According to information on the FDA Drug Shortages web site the shortage status of some parenteral nutrition (PN) components is now classified as “resolved”. However, for other products used to prepare PN admixtures shortages continue. The availability of PN components remains tenuous with supplies seeming adequate one day and unavailable the next.  

The latest PN components to be in short supply are dextrose 70% and sterile water for injection. Baxter Healthcare recently informed A.S.P.E.N. that Clinimix and Clinimix E have been put on a “protective allocation.” This product allocation is the result of increasing demand for Clinimix in response to a temporary shortage of sterile water and 70% dextrose across the market. It is intended to help maintain equal access to supply by Baxter customers. The allocation is expected to last through the remainder of the year.

According to the FDA Drug Shortage web site the following PN components are considered in short supply.  

Calcium gluconate injection
Cyanocobalamin (Vitamin B12) injection
Dextrose injection, 70%
Magnesium sulfate injection
Multi-vitamin infusion (adult and pediatric)
Phosphate (Glycophos) injection
Potassium chloride injection
Selenium injection
Sodium chloride 23.4% injection
Sodium phosphate injection
Sterile water for injection solutions
Trace elements (adult, pediatric and neonate)
Zinc injection

A.S.P.E.N. is continually addressing the ongoing shortage of vitamins, electrolytes, and other IV nutrition ingredients that has critically impacted hospitals and home infusion companies nationwide.  A.S.P.E.N. has developed and published recommendations to assist clinicians in managing shortages of PN components.  These strategies for rationing and conserving products are to be used only during shortages. Once a shortage of a PN component is resolved clinicians should provide patients with the full daily dose of that component. 
Parenteral Nutrition Component Shortages: Suggested Readings and Reports