Your Patients Are Asking — Here's How to Help

When patients learn their surgery may be delayed because of a supply shortage, anxiety and frustration are natural responses. As a provider, you're in a unique position to guide patients through the Mannitol/Sorbitol irrigation solution shortage — not just clinically, but practically.

This guide offers concrete steps you can take to help patients get the procedures they need, even when Sorbitol-Mannitol irrigation (2.7% Sorbitol / 0.54% Mannitol, 3,000 mL) remains on allocation from ICU Medical, the sole U.S. manufacturer.

For the clinical shortage overview, see our companion briefing: Mannitol/Sorbitol shortage: What providers need to know in 2026.

Current Availability Snapshot

As of early 2026, the key supply facts are:

• Manufacturer: ICU Medical (Otsuka ICU Medical LLC) — sole U.S. source
• Status: On allocation — hospitals receive limited quantities based on historical purchase volumes
• Packaging: 3,000 mL flexible bags and semi-rigid containers
• Price: Approximately $61 for 12,000 mL (four bags), or ~$15–$20 per bag
• Distribution: Available through McKesson, Cardinal Health, and other hospital distributors, subject to allocation limits

The Hurricane Helene-driven IV fluid crisis of 2024 has improved but not fully resolved. ASHP continues to track irrigation solutions on their shortage list.

Why Patients Can't Find It

Patients encountering this shortage often don't understand why a hospital would lack a basic surgical supply. Here's how to frame it:

• Single-source product: There is only one manufacturer of this specific combination product in the entire country. When that manufacturer is constrained, there's no backup.
• Hospital-only product: Mannitol/Sorbitol isn't available at retail pharmacies. Patients can't "shop around" the way they might for a prescription medication.
• Allocation-based distribution: Hospitals receive limited quantities each month, and once that allocation is used, they may need to wait for the next cycle.
• Cascading supply chain effects: Hurricane Helene's destruction of Baxter's facility created demand surges that are still working through the system 18+ months later.

What Providers Can Do: 5 Practical Steps

Step 1: Check Supply Before Scheduling

Make irrigation solution availability verification a standard part of your pre-scheduling workflow for TURP, hysteroscopy, and other procedures requiring nonelectrolytic irrigants.

• Contact your hospital pharmacy or supply chain team before finalizing elective case dates
• Ask specifically about Sorbitol-Mannitol allocation levels and expected delivery dates
• If supply is uncertain, have a backup plan ready (alternative irrigation solution or alternative facility)

Step 2: Leverage Multi-Site Availability

If you operate at multiple hospitals or ambulatory surgery centers:

• Compare irrigation solution inventory across your facilities
• Route patients to the facility with the best current supply when possible
• Coordinate with your practice scheduler to match patient cases with facility supply

For cross-facility availability checking, use Medfinder for Providers to quickly see which facilities near you have inventory.

Step 3: Evaluate Equipment Alternatives

The most effective long-term solution to the Mannitol/Sorbitol shortage is bipolar resectoscope technology:

• Bipolar TURP uses normal saline irrigation — widely available and eliminates the risk of TURP syndrome
• If your facility has bipolar equipment, prioritize its use during periods of nonelectrolytic irrigant shortage
• If bipolar equipment is not available, use the shortage as leverage to discuss capital equipment investment with hospital administration. The business case is strong: reduced supply chain risk, lower complication rates, and broader irrigation solution options.

Step 4: Know Your Alternative Irrigants

When Mannitol/Sorbitol is unavailable for monopolar procedures:

• Glycine 1.5% — Most established alternative. Multiple manufacturers. Higher neurological risk profile (4.8x relative risk vs. Mannitol per published data). Monitor fluid absorption closely.
• Sterile Water for Irrigation — Reserve for short procedures only due to hemolysis risk with absorption. Check ASHP — this product is also periodically on shortage.
• 5% Dextrose — Nonelectrolytic but limited evidence base for urologic irrigation. Monitor blood glucose in diabetic patients.

For clinical comparisons: Alternatives to Mannitol/Sorbitol.

Step 5: Communicate Proactively With Patients

Patients handle delays much better when they understand the "why" and have a plan:

• Explain the shortage in simple terms — one factory, one manufacturer, a hurricane that disrupted the supply chain
• Reassure patients that alternatives exist and that you'll choose the safest option for their specific situation
• Provide a realistic timeline for when their procedure can be scheduled
• Direct patients to reliable resources for self-service availability checking — share medfinder.com as a tool they can use

Patient-facing information they can read: Mannitol/Sorbitol shortage: What patients need to know.

Alternatives Summary for Quick Reference

• Normal Saline (0.9% NaCl): Best option if bipolar equipment is available. Widely available. No TURP syndrome risk.
• Glycine 1.5%: Best monopolar alternative. More available than Sorbitol-Mannitol. Higher neurological risk — monitor absorption.
• Sterile Water: Lowest cost, highest hemolysis risk. Short procedures only.
• D5W: Nonelectrolytic but hyperglycemia risk. Limited urologic evidence.

Workflow Tips for Your Practice

Build a Shortage Protocol

Create a standard operating procedure for your practice that includes:

1. Pre-scheduling irrigation supply verification (phone or electronic check with pharmacy)
2. Decision tree for alternative irrigation selection based on equipment and patient factors
3. Patient communication template explaining potential shortage-related delays
4. Monthly review of allocation status and supply forecasts with your hospital supply chain team

Track Usage and Forecast Needs

• Monitor your facility's monthly Mannitol/Sorbitol usage vs. allocation
• Plan elective case volumes based on realistic supply projections
• Avoid "just in time" scheduling for cases requiring specific irrigants — build buffer time

Collaborate With Pharmacy

Your hospital pharmacist is your best ally in shortage management:

• Establish a direct communication channel for real-time supply alerts
• Ask pharmacy to notify you immediately when Mannitol/Sorbitol shipments arrive
• Discuss emergency alternatives and ensure backup products are kept in stock

Final Thoughts

The Mannitol/Sorbitol shortage is a systemic supply chain issue, not something any individual provider can solve alone. But with proactive planning, clear patient communication, and clinical flexibility, you can minimize the impact on your practice and your patients' care.

Key resources for your practice:

• Medfinder for Providers — Real-time availability tracking
• Clinical shortage briefing for providers
• How to help patients save money on Mannitol/Sorbitol
• Mannitol/Sorbitol drug interactions