Hospitals across Maryland are scrambling to conserve IV fluids after damage from Hurricane Helene last month halted production at the country’s leading manufacturer and triggered a national shortage — which could worsen as Hurricane Milton drenches Florida this week.

Baxter International shut down its plant in Marion, N.C., about 35 miles east of Asheville, after it experienced severe flooding and a nearby bridge collapsed. The facility produced 1.5 million bags a day and accounted for 60% of the nation’s supply of IV fluids, according to the American Hospital Association.

Another key manufacturing plant, for B. Braun Medical in Daytona Beach, Florida, is in the path of Hurricane Milton. The company said that it planned to temporarily close the facility and that it had relocated its inventory farther north.

In a statement posted to its website Wednesday, Baxter said that as it has ramped up production at its global facilities, some customers are now able to receive up to 60% of what they typically order. There is no timeline on when production will resume in North Carolina.

IV fluids are administered into veins and are a simple and common way of keeping patients hydrated when they are ill, undergoing surgery or otherwise unable to eat or drink. In serious emergencies, they can also be used for resuscitation, to maintain blood pressure or counter fluid loss.

Last week, the Maryland Department of Health sent a letter alerting providers to the shortage, urging them to conserve IV fluids and issuing guidance on how to do so.

The state’s major hospital systems, many of which rely on Baxter as their primary provider of IV fluids, have made adjustments.

Luminis Health, which operates Anne Arundel Medical Center, suspended elective surgeries on Monday, though the hospital since resumed a regular schedule. The University of Maryland Medical System created a task force to manage its response. TidalHealth, which owns the only trauma center on the Eastern Shore, transitioned some patients from IV fluids to oral hydration. And LifeBridge, owner of Sinai Hospital in Baltimore, implemented pop-up notifications alerting providers to consider alternate bag sizes.

Theodore Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said the measures are necessary to preserve supply for those with the greatest needs.

“In cases of serious illness and trauma, IV fluids will continue to be used,” Delbridge said. “But we’ve asked clinicians to be more judicious in their use of fluids and to only use them when it’s deemed to be absolutely necessary in order to preserve the supply.”

Officials from the Greater Baltimore Medical Center said they expect deliveries from Baxter to remain limited for months. In the meantime, the Towson hospital has been more selective about which patients it starts on IVs, reserving the largest bags for the sickest patients and providing water and electrolytes as a substitute. Providers generally prefer IV fluids to oral hydration because they work more quickly.

“You consider IV fluids part of your practice,” said Cate O’Connor-Devlin, the hospital’s director of emergency preparedness, safety and security. “But when you have to really sit down and think that it is a scarce resource, then there are other ways that we can get you to be hydrated without having to hang the IV fluids.”

Delbridge said that while emergency services across the state have been unaffected, elective procedures could be at risk the longer the shortage continues.

In a statement, the Maryland Hospital Association encouraged Marylanders with non-emergency health concerns to consider alternate services.

A number of hospital systems said they are attempting to bolster their supply of IV fluids from other vendors. But there are challenges. Some manufacturers, worried about Baxter customers depleting their supply, are currently only accepting orders from existing clients.

The American Hospital Association asked President Joe Biden on Monday to declare a national emergency and enact temporary measures to boost supply, including permitting hospitals to prepare IV solutions in their own pharmacies, extending expiration dates and identifying international manufacturers.

Between weather events, the COVID-19 pandemic and other supply chain issues, health care providers have become accustomed to dealing with shortages of resources.

In 2017, damage from Hurricane Maria shut down another Baxter plant in Puerto Rico. IV shortages can be more significant “because of the sheer proportion of people that present for healthcare who get IV fluids,” Delbridge said.

Officials say these recent hurricanes should serve as a warning about depending too heavily on a single manufacturer and better planning for emergencies.

“There’s always the opportunity to diversify your supplier base,” said Brian Riemer, GBMC’s vice president of supply chain.

He also said hospitals should constantly think about emergency preparedness.

“If this category goes on shortage, how would we respond? What would we do?,” he said. “To have that in place and have that thought through before it even happens is very helpful.”

This story has been updated to correct the amount of fluid customers are able to receive from Baxter.