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While the COVID-19 pandemic continues to muddle supply chains and raise demands for routine medical items, the latest nationwide drug shortage facing healthcare providers involves the intravenous formulation of potassium chloride.

Joel Topf, MD, a nephrologist in Detroit, on December 15. He posted the contents of a memo from his institution that read in part, "We have been notified by pharmacy that there is a nationwide shortage of intravenous potassium chloride. It is unclear when we will get additional supplies. With the exception of ICU and a few procedural areas most of the remaining supply has been pulled ... Please use oral forms of [potassium chloride] whenever possible."

The shortage is affecting pediatric patients' nutrition and replenishment of electrolytes, especially neonates, said Jason Tomichek, PharmD, of the Department of Pharmaceutical Services at Vanderbilt University Medical Center in Nashville.

"It is mainly isolated to the concentrated form," he told 番茄社区."We've been dealing with it for the last 3 months."

It started "popping up on our radar" in September, but there was product in the marketplace through the beginning of November. Then it suddenly dried up, he added.

That is typical of a shortage -- there are "rumblings" of it coming and then it hits the market, Tomichek said. "We're hoping this is relatively short-term."

More lots of the drug are expected to be released early in the first quarter of 2022. But even so, Tomichek doesn't expect a full recovery from the shortage right away.

"Here at Vanderbilt, we've been able to continue to treat our patients," Tomichek noted. However, it has taken internally changing some processes to help conserve supply.

"If this does not recover, if it gets pushed back from Q1, we will definitely have to get very creative with how we treat these patients," he added.

Matthew Sparks, MD, of Duke University School of Medicine in Durham, North Carolina, said that while he was not yet aware of any impacts from the specific shortage, this news is concerning for healthcare providers.

"Potassium chloride is an important medication to have in any functional hospital," Sparks told 番茄社区. "Many different types of patients have low potassium. A lot of them are in intensive care units. And so it does scare me to think about a hospital that would not have access to intravenous potassium chloride."

Sparks likened potassium chloride in medicine to the bricks, boards, and nails needed to build a house. "It just cuts across many different types of patients," he said.

The FDA's Drug Shortages database lists potassium chloride concentrate injection as currently in shortage, with just a few manufacturers: B. Braun Medical, Fresenius Kabi, and Hospira (which was acquired by Pfizer several years ago). Fresenius Kabi listed manufacturing delays as the reason for the shortage, while Pfizer listed an increase in demand. Pfizer is expecting next deliveries in January and full recovery between the first and fourth quarter of 2022.

In the meantime, other drug shortages have also worried healthcare providers.

Last month, a shortage of tocilizumab (Actemra) was reported, affecting patients with rheumatoid arthritis, as well as those with cytokine release syndrome associated with cancer treatment. The FDA authorized the drug for the treatment of severe COVID-19 in June.

"We're suffering in the healthcare industry in getting supplies and drugs," Tomichek said.

The marketplace has progressively gotten worse over the course of the pandemic -- not only for drugs, but also everyday supplies down to sterile gloves, putting continued strain on the healthcare system, he added.

To help address the shortages, Tomichek said the usual plan at Vanderbilt is to put together an allocation committee of doctors, nurses, and hospital leaders to discuss how to conserve and maximize drugs on hand.

But it is not always easy to pull resources when it comes to drug shortages or any kind of shortage. "I'm sure some other hospitals may not have those resources, and may struggle," Tomichek said.

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