Hydration beyond water

Hydration is essential for maintaining overall health, especially for vulnerable populations such as the elderly, children, diabetics, and individuals experiencing illnesses like fever or respiratory infections. Silent dehydration — where the body loses fluids and electrolytes without clear symptoms, typically in non-diarrhoeal conditions — is a widespread yet under-recognised issue.

Left unaddressed, silent dehydration can significantly impact recovery, cognitive function, and overall well-being. A holistic approach to hydration, incorporating fluids, electrolytes, and energy (Oral FEE), is essential, particularly with the increasing availability of ready-to-drink (RTD) electrolyte solutions.

Understanding silent dehydration

Silent dehydration occurs subtly and often goes unnoticed due to the absence of typical symptoms like severe thirst or visible sweating. It is common in non-diarrhoeal conditions such as fever, respiratory infections, heat-related illnesses, and during daily activities that lead to fluid loss. Vulnerable groups, like the elderly, are particularly affected due to factors such as smaller fluid reserves, impaired thirst response, and the presence of coexisting medical conditions.

Key risk factors for silent dehydration

A rise in body temperature of just 1°C (1.8°F) can increase fluid loss by up to 10%, potentially leading to a deficit of 1 litre per day. Fever also elevates metabolic rates, raising energy demands while reducing appetite.

• In children: Their higher surface area-to-body mass ratio, faster metabolic rates, and less efficient kidney function make them more vulnerable to dehydration.

• In the elderly: Decreased muscle mass, reliance on medications like diuretics, and diminished thirst sensitivity elevate the risk of dehydration in older adults.

• In diabetics: Elevated blood glucose levels and medications like SGLT2 inhibitors increase urination, exacerbating fluid loss and electrolyte imbalance.

Why Oral FEE?

Hydration isn’t just about replenishing water; it also involves restoring electrolytes and energy to support physiological functions. Key electrolytes such as sodium, potassium, and magnesium regulate nerve and muscle activity, maintain fluid balance, and aid overall recovery. Non-diarrhoeal illnesses, particularly in the elderly, can further intensify dehydration and hinder recovery. The recommendations of the Indian expert panel highlighted the need to address fluid, electrolyte, and energy deficits at the onset of non-diarrhoeal illness. RTD electrolyte drinks with balanced glucose levels can enhance absorption, providing quicker hydration and energy replenishment than plain water.

Practical recommendations for elderly populations

Silent dehydration is a hidden yet significant health concern, particularly for vulnerable populations like the elderly. It can impair recovery from non-diarrhoeal conditions and worsen pre-existing health issues.

A holistic approach that integrates fluids, electrolytes, and energy is crucial for effectively addressing dehydration. RTD electrolyte solutions provide a practical, balanced option for managing silent dehydration, ensuring enhanced hydration and improved adherence to recovery protocols.

By recognising the signs of silent dehydration and incorporating evidence-based solutions like Oral FEE, we can improve recovery outcomes, enhance well-being, and develop a more robust approach to managing hydration in vulnerable groups.

Hydration is not just about quenching thirst; it’s about restoring balance, supporting recovery, and building resilience against health challenges.

Elderly individuals often depend on family members for daily care, so caregivers should be aware of their dietary and fluid needs and ensure proper hydration and rehydration.

Scientifically formulated ready-to-drink solutions for oral rehydration should be preferred over homemade fluids to avoid risks of preparation errors.

Carbonated beverages and fizzy energy drinks should be avoided due to their potential to worsen dehydration.

High potassium levels in fruit juices may pose a concern for individuals with diabetes or chronic kidney disease.

Role of Oral FEE

Fluids: Replenish lost water to maintain hydration.
Electrolytes: Restore vital minerals to reduce susceptibility to muscle cramps, fatigue, and dizziness.
Energy: An optimal amount of energy, paired with sodium, is required for water absorption.

Limitations of traditional hydration solutions

While homemade remedies like fruit juices or coconut water are commonly suggested, they may not provide comprehensive hydration.
• Homemade solutions: Preparation errors and an unbalanced glucose-to-sodium ratio can impair water absorption.
• Coconut water: Nutrient composition can vary depending on species and origin.
• Plain water: Lacks electrolytes and energy, increasing the risk of complications during illness.
While WHO ORS (Oral Rehydration Solution) is effective for diarrhoea-related dehydration, its low energy content makes it insufficient for non-diarrhoeal
conditions.
For such conditions, Ready To Drink (RTD) electrolyte drinks provide a superior solution with a balanced formulation of fluids, electrolytes, and energy.

Benefits of RTD electrolyte solutions

Ready To Drink electrolyte solutions are a preferred choice for managing silent dehydration, especially in non-diarrhoeal conditions. Their benefits include:
• Balanced composition: Fixed electrolytes and energy concentrations tailored for hydration and recovery.
• Convenience: Hygienic, ready-to-consume packaging ensures ease of use.
• Palatability: Enhanced taste improves adherence, particularly during periods of reduced appetite.
These solutions are particularly beneficial during illnesses like fever, where altered taste and appetite affect compliance with hydration protocols.

Disclaimer: This article addresses mild to moderate non-diarrhoeal dehydration only. The information provided is based on scientific research and is not a substitute for professional medical advice. Please consult a healthcare provider for more information about effective hydration during non-diarrhoeal illness.

(The author is a senior gastrointestinal & general surgeon.)