Role of oral fluid, electrolytes and energy in various pediatric illnesses beyond diarrhea: an Indian expert panel consensus recommendation

Apurba Ghosh; Ashish Ramesh Bavdekar; Nishant Wadhwa; Pavitra Chakravarty; Rahul Nagpal; Somashekar A. R.; Janani Shankar; Eileen Canday; Haritha Bathina; Christian Tesado; Priti Thakor; Harshad Malve

doi:10.18203/2349-3291.ijcp20230452

Authors

Apurba Ghosh Institute of Child Health, Kolkata, West Bengal, India
Ashish Ramesh Bavdekar Pediatric Gastroenterologist and Pediatric Research, Department of Pediatrics, K.E.M. Hospital, Pune, Maharashtra, India
Nishant Wadhwa Pediatric Gastroenterology and Hepatology, Pediatric Liver Transplantation, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, Delhi, India
Pavitra Chakravarty Columbia Asia Hospital, Kolkata, West Bengal, India
Rahul Nagpal Fortis Hospital, Vasant Kunj, New Delhi, Delhi, India
Somashekar A. R. Department of Pediatrics, M.S. Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
Janani Shankar Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
Eileen Canday Department of Dietetics and Nutrition Department, Sir H. N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
Haritha Bathina Department of Nutrition and Dietetics, Apollo Hospitals, Hyderabad, Telangana, India
Christian Tesado Johnson and Johnson Consumer Health, Medical Affairs, AP, Singapore
Priti Thakor Medical Affairs, Johnson and Johnson Consumer Health India, Mumbai, Maharashtra, India
Harshad Malve Medical Affairs, Johnson and Johnson Consumer Health India, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20230452

Keywords:

Dehydration, Non-diarrheal illnesses, Oral rehydration, Ready-to-drink

Abstract

Dehydration in non-diarrheal illnesses often goes unnoticed and there are no consensus treatment recommendations for management of dehydration in non-diarrheal illnesses. A multi-disciplinary committee of 10 experts from India gathered on virtual platform in September 2020 to develop consensus recommendation on current treatment strategies for managing oral fluid electrolyte and energy in pediatric patients during non-diarrheal illnesses and to identify unmet needs and gaps. A pre-meeting questionnaire-based voting system was adopted to reach consensus followed by a discussion between panel members. In absence of consensus, the topic was opened for debate to arrive at an aligned recommendation. Key clinical challenges include identifying dehydration in acute illnesses and recommending appropriate quantity and type of oral fluids based on symptom severity. This consensus statement provides guidance on management of dehydration in non-diarrheal illnesses including recommendation on oral fluid, electrolytes, and appropriate energy management in pediatric population. Oral fluid, electrolyte and energy supplementation were recommended based on symptoms in acute non-diarrheal illness increased insensible losses and/or decreased intake. Oral rehydration fluids should be prescribed accurately and at the right-time for countering dehydration, ideally early in the course of illness. Prescribing pattern should be precise and like intravenous fluids. Carbonated drinks and canned juices should not be recommended. Plain water may not be optimal in replacing electrolytes especially for anorexic patients who can only tolerate fluids. These clinical practice statements provide guidance for oral fluid, electrolytes, and energy recommendations for pediatric patients with various acute illnesses beyond diarrhea.

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