Art of Medicine
Aug 2019

Normal Saline

Hannah Rebeccah Abrams
AMA J Ethics. 2019;21(8):E699-700. doi: 10.1001/amajethics.2019.699.


In 2017, Hurricane Maria devastated Puerto Rico and prompted a shortage of normal saline in US health care organizations. This graphic narrative considers ethics and justice in the supply, demand, and allocation of intravenous fluids in clinical settings during this time.


Figure. “Normal” Saline: Shortage, Supply, and Solutions

Figure 1 artm1-1908


Marker and pencil on printing and tracing paper.

In 2017 and 2018, more than 40 critical medications were in short supply following destruction of drug manufacturing plants in Puerto Rico by Hurricane Maria.1 In response, government agencies, clinicians, and health care organizations coordinated intravenous fluid allocation to US-based clinical settings. This crisis illuminated the need for researching saline conservation and triage protocols and for diversifying medication suppliers’ manufacturing sites.


  1. Konrad W. Why so many medicines are in short supply months after Hurricane Maria. CBS News. February 12, 2018. Accessed May 2, 2019.


AMA J Ethics. 2019;21(8):E699-700.



Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose. 

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.