ACEP ID:

May 13, 2022

Clinical Alert: Shortages in Iodinated Contrast Media, Baby Formula

Iodinated Contrast Media Shortage

There is a global shortage of iodinated contrast media. It appears to be caused by a COVID-related interruption in the supply chain from Shanghai, which produces 80% of iodinated contrast. This shortage is expected to last well into June and possibly July before returning to normal supply levels.

You may be asked to restrict the use of imaging with contrast, or substitute other studies. Some common substitutions are a VQ nuclear medicine scan for PE or ultrasound for appendicitis. Your facility may or may not have the capability of doing these tests 24/7. Access to testing off hours and substitution of tests should be discussed with your local radiologist who can help determine which tests can be utilized at your site.

 ACEP has discussed this issue with the FDA, but there does not seem to be a short term fix. We will continue to work with them until this is resolved.

The American College of Radiology has provided this information regarding the shortage and recommended actions.

With the help of several ACEP members, we have prepared smart phrases that can be copied and inserted into the medical record. Please edit these for your local circumstances and your current practice. While these are not a guarantee against medicolegal issues in the future, it will be a reminder for you and your patient that they were seen during a time of shortage.

Notation for the chart:

This patient was evaluated during a time of global shortage of iodinated contrast media. Based on guidance from the American College of Radiology, best practices, and local institutional approaches an alternative path for evaluating and managing the patient may have been employed in order to provide optimal care during this shortage. The current situation has been discussed with the patient.

Notation for the patient’s discharge paperwork:

Please be aware that you were seen during a time of global shortage of iodinated contrast media. This means an alternative approach to your diagnosis and treatment may have been employed in order to provide optimal care during this shortage. If you have any worsening symptoms, please go to the nearest Emergency Department or call 911 immediately.

 

Baby Formula Shortage

For those of you who see children, there is national shortage of baby formula, though this shortage appears to be getting better. Because of the shortage, mothers may dilute their remaining formula or resort to using a substitute.

Consider the use of diluted formula in infants presenting with seizures or electrolyte imbalance. Cow’s milk contains high concentrations of protein and minerals, which can stress a newborn's immature kidneys and cause severe illness at times of heat stress, fever, or diarrhea. Infants cannot digest cow's milk as completely or easily as they digest formula. In addition, cow's milk lacks the proper amounts of iron, vitamin C, and other nutrients that infants need. It may even cause iron-deficiency anemia in some babies, since cow's milk protein can irritate the lining of the stomach and intestine, leading to loss of blood in the stools.

The potential problems with homemade formulas include contamination and absence of or inadequate amounts of critical nutrients. These problems are very serious, and the consequences range from severe nutritional imbalances to foodborne illnesses.

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