Role of Oral Fluid, Electrolytes and Energy in various pediatric illnesses beyondDiarrhea: An Indian Expert Panel Consensus Recommendation

Background: Dehydration in non-diarrheal illnesses often goes unnoticed and there are no consensus treatment recommendations for management of dehydration in non-diarrheal illnesses. Main Body: A multi-disciplinary committee of 10 experts from India gathered on a virtual advisory–board meeting on September 2020 to develop a consensus recommendation on current treatment strategies for managing oral fluid electrolyte and energy in pediatric patients during non-diarrheal illnesses and to identify unmet evidence-based 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, electrolyte and appropriate energy management in pediatric population. Conclusions: : The group proposed the need for oral fluid, electrolyte and energy supplementation, which should be 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 similar to 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, electrolyte and energy recommendations for pediatric patients with various acute illnesses beyond diarrhea.