Title : Oral Fluid, Electrolytes and Energy Management in Various Adult and Geriatric Illnesses Beyond Diarrhea: An Indian Expert Panel Delphi Consensus Recommendation
Statement of the Problem: Dehydration is a highly prevalent issue which many a time goes undetected causing delayed recovery, and an increased risk of hospitalization and mortality. Specific to non-diarrheal dehydration, very few international guidelines provide recommendations of oral fluids, electrolytes, and energy (FEE) management in adult/geriatric patients. Moreover, there is a lack of comprehensive recommendation on the role of oral FEE in non-diarrheal illnesses.
Methodology: A modified Delphi approach was used to develop consensus recommendations on the management of oral FEE in Indian adult/geriatric patients with non-diarrheal illnesses. In round one, 130 statements including 21 open-ended questions were circulated among ten experts consisting of a gastrointestinal surgeon, diabetologist, infectious disease and critical care specialist, gastroenterologist, internist, and a dietician. The expert panel was then asked to either ‘strongly agree, ‘agree’, ‘disagree’, or ‘strongly disagree’ for statements and provide responses to open-ended questions and every disagreement were open for debate to arrive at conclusive statement. Consensus was pre-defined at 75% agreement. Presentation of relevant literature was done before and during two virtual discussions. Some statements were actively discussed and deliberately debated. Those that did not reach consensus were re-circulated for another round.
Findings: Overall, the final consensus covered various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic non-diarrheal illnesses. Oral FEE should be recommended as part of core treatment from day 1 of illness for improved patient outcomes. Appropriately formulated fluids in a ready-to-drink format is a good option due to its quality-standard, convenience, known electrolyte and energy content, and more palatable, which improves compliance.
Conclusion & Significance: These consensus statements provide a guidance for oral fluids, electrolytes, and energy recommendations for adult/geriatric patients with various non-diarrheal illnesses.