The Shortage That Started With a Hurricane — and Hasn't Fully Ended

In September 2024, Hurricane Helene slammed into western North Carolina, flooding Baxter International's North Cove manufacturing plant — the facility responsible for producing roughly 60% of America's IV fluids and irrigation solutions. What followed was the worst sterile fluid shortage in recent U.S. history, and its effects are still being felt in 2026.

Mannitol/Sorbitol irrigation solution, a critical fluid used during transurethral and hysteroscopic surgeries, is among the products still affected. Here's what patients need to know right now.

Is Mannitol/Sorbitol Still in Shortage?

Yes. As of early 2026, Mannitol/Sorbitol irrigation solution remains on allocation from ICU Medical, the sole U.S. manufacturer of the combination product. This means hospitals and surgical centers can only order limited quantities based on their historical purchasing patterns.

The American Society of Health-System Pharmacists (ASHP) continues to list multiple sterile fluid and irrigation products on their current drug shortage list. While the situation has improved significantly from the crisis peak in late 2024, supply has not fully returned to pre-hurricane levels for all products.

Why Is It Still Hard to Find?

Several factors continue to constrain supply:

• Single manufacturer: ICU Medical (through Otsuka ICU Medical LLC) is the only company producing the Sorbitol-Mannitol irrigation combination in the U.S. Any disruption to their production or distribution directly impacts the entire national supply.
• Lingering demand surge: Even though Baxter's North Cove facility has largely recovered, the months of disruption shifted purchasing patterns and depleted hospital stockpiles. Rebuilding those reserves takes time.
• Ongoing allocation limits: ICU Medical continues to manage supply through allocation to ensure equitable distribution, which means some facilities may receive less than they need.
• Broader IV fluid market fragility: The sterile fluid supply chain has experienced periodic shortages since 2018 due to limited manufacturers, aging infrastructure, and high production costs. Hurricane Helene simply amplified an existing vulnerability.

For a deeper dive, read: Why is Mannitol/Sorbitol so hard to find?

What Does Mannitol/Sorbitol Cost in 2026?

Mannitol/Sorbitol irrigation solution is not a retail pharmacy product — it's a hospital-use surgical supply. Patients don't typically purchase it directly. Instead, the cost is rolled into your surgical facility fees.

For reference, the cash price for Mannitol/Sorbitol irrigation is approximately $61 for a 12,000 mL supply (four 3,000 mL bags). Per bag, that works out to roughly $15–$20. However, during shortages, some distributors may charge premium pricing, and facilities may absorb increased costs that get passed along in overall surgical fees.

The cost is typically covered under:

• Medicare Part A (inpatient hospital stays)
• Medicare Part B (outpatient surgical procedures)
• Private insurance as part of the surgical facility fee

For tips on managing costs, see: How to save money on Mannitol/Sorbitol in 2026.

Are There New Options Available?

While no new manufacturers have entered the Sorbitol-Mannitol combination market, the shortage has accelerated some positive changes:

Growth of Bipolar Surgical Technology

More hospitals and surgery centers are investing in bipolar resectoscopes, which allow surgeons to use normal saline (0.9% Sodium Chloride) instead of nonelectrolytic solutions like Mannitol/Sorbitol. This shift has been happening for years, but the shortage has given it new urgency. If your facility has bipolar equipment, the Mannitol/Sorbitol shortage may not affect your procedure at all.

Alternative Irrigation Solutions

Surgeons have adapted by using:

• Glycine 1.5% — the most common monopolar alternative
• Normal Saline — for bipolar procedures
• Sterile Water for Irrigation — for shorter procedures with minimal absorption risk

Learn more: Alternatives to Mannitol/Sorbitol.

FDA Flexibility Measures

During the height of the shortage, the FDA authorized emergency measures including extended expiration dates for some IV and irrigation products and temporary importation of products from Canadian manufacturing facilities. Some of these measures may still be in effect in 2026, expanding the available supply.

How to Find Mannitol/Sorbitol in Stock

If your procedure specifically requires Mannitol/Sorbitol, here's how to track it down:

1. Use Medfinder: Visit medfinder.com to check which facilities near you have current inventory.
2. Ask your surgeon's office: Your surgical team can check with their hospital pharmacy and supply chain department.
3. Consider alternative facilities: If your primary hospital is out of stock, ask if your surgeon operates at other locations that may have supply.
4. Check scheduling: Allocation cycles often reset monthly — scheduling early in the month may improve your chances.

For more detailed tips, read: How to find Mannitol/Sorbitol in stock near you.

Final Thoughts

The Mannitol/Sorbitol shortage has been an ongoing challenge for hospitals and patients since Hurricane Helene disrupted the IV fluid supply chain in September 2024. While conditions have improved, the product remains on allocation in 2026, and some facilities still experience spot shortages.

The key takeaways for patients:

• Your surgery can likely still happen — with Mannitol/Sorbitol if available, or with a safe alternative
• Bipolar surgical technology is increasingly available and eliminates the need for nonelectrolytic irrigation solutions
• Tools like Medfinder can help you find facilities with current supply
• Stay in communication with your surgeon about the best plan for your specific procedure

For a complete overview of this medication, visit: What is Mannitol/Sorbitol?