Saline crisis looms large as number of dengue patients soars

There is a shortage of intravenous saline in the market. The demand for intravenous saline has soared as the number of dengue patients is rising. However, the supply is not enough as compared to demand. This crisis of saline came to the fore while speaking to concerned government officials, physicians and employees of medicine stores.

Physicians usually prescribe intravenous saline for dehydration, diarrhoea or cholera and to keep blood pressure stable sometimes. The demand of saline rises when there is a sudden outbreak of cholera or diarrhoea. Dengue patients also need saline on a regular basis.

Speaking to Prothom Alo, Professor Salahuddin Shah of the haematology department of the Bangabandhu Sheikh Mujib Medical University (BSMMU) said that the water content of the blood reduces rapidly in dengue patients, which increases blood concentration and reduces blood pressure. The patients are given saline to maintain blood fluidity and to keep the blood pressure stable, he added.

He further said that a patient usually needs one to two litres of saline a day. Some patients need more than that.

More than 59,000 dengue patients have been admitted to hospitals so far this year. According to the figures of the Directorate General of Health Services (DGHS), these patients are staying in the hospitals for more or less three days on average. Besides, many are undergoing treatment at home on the advice of physicians. They are being given intravenous saline too. The pharmaceutical companies were not prepared for such a situation.

There are mainly four types of intravenous saline. Of them, only the normal saline is used for treating dengue patients.

The Institute of Public Health Nutrition under the DGHS used to produce intravenous saline, which were used in government hospitals. However, the production was halted some three to four years ago without making any alternative arrangements. It was said at the time that only the Essential Drug Company Limited (EDCL), the lone drug manufacturing company of the government, will produce intravenous saline.

Speaking to Prothom Alo on Thursday, EDCL managing director professor Ehsanul Kabir said EDCL will start producing saline at its factory in Gopalganj within a few months.

The patients in the government hospitals get intravenous saline free of cost. The EDCL now buys saline from private pharmaceutical companies to supply it to government hospitals, EDCL officials said. EDCL purchases saline from seven pharmaceutical companies – BEXIMCO, Square, Acme, Popular, Orion, Libra and Opsonin.

EDCL general manager (distribution) Zakir Hossain told Prothom Alo, “We are struggling to keep up with the demand of intravenous saline in government hospitals. We have resorted to rationing in some cases. The hospitals have been directed to ask the patients to buy saline with their own money in case the hospital is running out of saline.”

The EDCL supplied 6 million bags of saline to different government hospitals across the country last. Mohammad Zakir Hossain said the number could exceed 10 million this year.

There are 500 beds in the Mugda Medical College Hospital in the capital. However, the number of newly admitted dengue patients was more than 600 in some days last month. Besides, there were other patients. As a result, the demand for medicine, saline and food skyrocketed overnight. There were several media reports at the time that families of patients were seen buying saline from pharmacies outside the hospital.

On condition of anonymity, an official of that hospital told Prothom Alo that the hospital now has enough saline in stock. The Shaheed Suhrawardy Medical College Hospital authority said that they could tackle the demand for a week at most with their stock of saline.

Meanwhile, Chattogram civil surgeon Mohammad Ilias Chowdhury told Prothom Alo’s Chattogram correspondent, “I have come to know about the crisis of intravenous saline in different hospitals from different sources. I have informed the district administration and the concerned drug administration about this. They are taking necessary initiatives in this regard. They are also checking whether anyone is stocking intravenous saline illegally or not.”

Speaking to this correspondent, an employee of a drug store in the capital’s Kathalbagan area said, “We are out of intravenous saline for more than a week. We used to buy saline from four companies. However, there is no supply at the moment.”

This correspondent spoke to owners and employees of four medicine stores in Shahbagh area of the capital Thursday. There was no saline in three of these stores. Only one of these four pharmacies had intravenous saline in their stock.

The BSMMU authority has opened a dengue ward on the second floor of the F block of the hospital. Visiting the ward on Thursday, almost all the patients had cannula for intravenous inserted in their hands.

Speaking regarding this, professor Salahuddin Shah, chairman of the haematology department of BSMMU, said, “The hospital director has told us that there is a little crisis of intravenous saline.”

A senior physician at a private hospital in the capital’s Green Road area told Prothom that they learnt from several patients that normal saline was not available at the drug stores. Then, the hospital authority decided to use the intravenous saline only for treating dengue patients and it would not be available for other patients in the hospital. This correspondent checked 11 medicine stores in Mirpur -12, Mirpur - 11, Mirpur -10, Kazipara, Shewrapara and Agargaon, but there was no intravenous saline in any of these.

Neither the DGHS, nor the Directorate General of Drug Administration (DGDA) knows the yearly demand of intravenous saline in the country. The DGDA says that the demand of saline goes up in case of outbreak of diseases like diarrhoea or dengue. However, the officials in charge of the hospitals can provide an exact number in this regard.

Speaking to Prothom Alo, DGHS director (hospital) Habibul Hasan said, “The DGDA might have known the exact demand of intravenous saline.”

Several pharmaceutical companies said yesterday (Thursday) that they have maintained the production rate. Asked about the reasons behind the crisis despite no decline in production, DGDA director (administration) Md Salahuddin told Prothom Alo, “There is no shortage of saline. The demand has surged due to the dengue situation. We have asked the pharmaceutical companies to continue uninterrupted production and to take initiatives to further expand production. The government will provide all the necessary assistance in this regard.”

Several physicians and medicine sellers say there are chances of the dengue situation taking a severe turn if the government does not take any major initiative.

Professor Be-Nazir Ahmed, former director of the disease control unit of the DGHS and public health expert, “The number of dengue patients did not increase overnight. We should have been precautious. The pharmaceutical companies will have to expand production. The risk of dengue related casualties will increase as well as patient management will be very difficult if a crisis of saline arises in the hospitals.”

*This report appeared on the print and online versions of Prothom Alo and has been rewritten in English by Ashish Basu