Provider Briefing: Sodium Chloride Supply in 2026

The 2024-2025 IV saline shortage was one of the most significant drug supply disruptions in recent U.S. history. As a provider, you likely experienced its effects firsthand — delayed procedures, rationed IV fluids, and patients struggling to access routine hydration therapy.

As we move into 2026, supply has largely recovered, but the lessons learned — and residual challenges — deserve attention. This briefing covers the shortage timeline, current availability, prescribing considerations, and resources to help your patients and practice navigate ongoing supply dynamics.

Shortage Timeline

Understanding the timeline helps contextualize where we are today:

• Pre-2024: IV fluid supplies were already constrained due to just-in-time manufacturing, limited domestic production capacity, and recurring minor disruptions. Previous saline shortages occurred in 2014 and 2017-2018.
• September 2024: Hurricane Helene strikes western North Carolina, causing catastrophic damage to Baxter International's North Cove manufacturing facility — the source of approximately 60% of U.S. IV saline production.
• October-December 2024: Hospitals nationwide implement conservation protocols, delay elective surgeries, and switch to alternative crystalloids. The FDA activates emergency measures including temporary importation of foreign-manufactured IV fluids.
• January-May 2025: Baxter progressively restores production lines. Other manufacturers (B. Braun, ICU Medical, Fresenius Kabi) increase output. Supply gradually improves but remains below pre-hurricane levels.
• August 8, 2025: FDA officially declares the shortage of 0.9% Sodium Chloride Injection resolved and removes it from the Drug Shortage Database.
• 2026: Supply is largely normalized, though infrastructure vulnerabilities remain. Some facilities report intermittent spot shortages of specific bag sizes or flush syringes.

Prescribing Implications

The shortage accelerated a trend that was already underway in evidence-based practice: the shift toward balanced crystalloids.

Normal Saline vs. Balanced Crystalloids

The SMART trial (2018) and SALT-ED trial demonstrated that balanced crystalloids like Lactated Ringer's and Plasma-Lyte A may reduce the incidence of major adverse kidney events compared to 0.9% Sodium Chloride in critically ill patients. During the shortage, many institutions shifted their default IV fluid from Normal Saline to Lactated Ringer's — and many have chosen to keep that change in place.

Clinical considerations when selecting IV fluids:

• 0.9% NaCl (Normal Saline): Preferred for hyponatremia, metabolic alkalosis, and as a vehicle for certain medications incompatible with balanced solutions. Contains 154 mEq/L each of sodium and chloride.
• Lactated Ringer's: Preferred for surgical patients, trauma resuscitation, and general fluid replacement. Avoid in patients receiving Ceftriaxone (calcium interaction) or those with severe hepatic dysfunction.
• Plasma-Lyte A: Most physiologically balanced option. Appropriate for most clinical scenarios. Higher cost may limit availability in some settings.
• 0.45% NaCl: Appropriate for maintenance fluids and hypernatremia correction. Not suitable for volume resuscitation.

Non-IV Formulations

For patients using Sodium Chloride outside the hospital setting:

• Nebulizer saline (0.9%, 3%, 7%): Generally available. Hypertonic concentrations may require specialty pharmacy sourcing.
• Nasal saline: OTC availability is robust. Multiple brands available without prescription.
• Ophthalmic (Muro 128): Supply has been stable. Generic alternatives exist.

For a detailed comparison of alternatives, see Alternatives to Sodium Chloride.

Current Availability Picture

As of early 2026:

• 0.9% NaCl IV bags: Normal supply at most distributors. Allocation limits have been lifted.
• IV flush syringes: Generally available, with occasional spot shortages at smaller facilities.
• Hypertonic saline (3%, 5%): Adequate supply for ICU and emergency use.
• Nebulizer saline: Available through retail and specialty pharmacies.
• Bacteriostatic NaCl: Available for reconstitution needs.

For real-time availability data, Medfinder for Providers can help you and your patients locate specific Sodium Chloride formulations at nearby pharmacies.

Cost and Access Considerations

Sodium Chloride remains one of the most affordable medications in healthcare:

• Outpatient prescription formulations: $7 to $20 with discount coupons (nebulizer saline, for example, as low as $7.68 with GoodRx Gold)
• OTC nasal saline: $3 to $8
• IV bags (wholesale): $5 to $15 per liter

Insurance coverage is generally not an issue for prescription formulations. Normal Saline is covered by virtually all plans without prior authorization or step therapy requirements. OTC formulations are typically not covered but are inexpensive enough to be manageable for most patients.

For patients with financial hardship, hospital financial assistance programs and organizations like NeedyMeds may provide additional support for home infusion needs.

Tools and Resources for Your Practice

Here are resources to help manage Sodium Chloride access for your patients:

• Medfinder for Providers: Real-time pharmacy availability search. Help patients find Sodium Chloride in stock near them.
• FDA Drug Shortage Database: Monitor current and emerging shortages at accessdata.fda.gov.
• ASHP Drug Shortage Resource Center: Clinical guidance and alternatives during shortages.
• Institutional pharmacy contacts: Maintain relationships with your hospital or health system pharmacy for early warning of supply changes.

For patient-facing resources you can share, consider these articles:

• How to Find Sodium Chloride in Stock Near You
• Sodium Chloride Shortage Update for Patients
• How to Save Money on Sodium Chloride

Looking Ahead: Building Supply Chain Resilience

The saline shortage exposed critical vulnerabilities in the U.S. pharmaceutical supply chain:

• Concentration risk: A single facility producing 60% of a critical medication's supply represents an unacceptable single point of failure.
• Just-in-time inventory: Minimal buffer stock at hospitals and distributors amplified the impact of production disruptions.
• Limited domestic manufacturing: Sterile injectable production requires specialized facilities with significant lead times to build or expand.

Federal efforts are underway to address these issues, including incentives for new manufacturing capacity and strategic stockpile expansion. As providers, advocating for supply chain resilience — through professional organizations and institutional leadership — remains important.

Final Thoughts

The 2024-2025 Sodium Chloride shortage was a wake-up call for U.S. healthcare. While supply has largely recovered, the structural vulnerabilities that enabled the crisis remain. Staying informed, maintaining clinical flexibility with crystalloid selection, and leveraging tools like Medfinder to help patients navigate access challenges are practical steps every provider can take.

For a patient-focused perspective on the shortage, see our patient shortage update. For guidance on helping patients find medications, read How to Help Your Patients Find Sodium Chloride in Stock.