This guideline addresses the needs for restoration of fluids during illness, principles of restoration, probable impact on recovery and suitable criteria for an ideal restoration guideline.

Water and electrolytes balance is crucial for body homeostasis and is one of the most important physiological mechanisms in the body. While we can survive for months without food, without water intake we die very quickly.

Similarly, the body has a strong mechanism to control salt and water balance, an understanding of which has major implications in clinical practice.

In 1967, Moore and Shires wrote; “the objective of care is restoration to normal physiology and normal function of organs, with a normal blood volume, functional body water and electrolytes. This can never be achieved by inundation.”

Fluid restoration refers to the maintenance of fluid and energy balance in the body. It is needed in both healthy individuals and in those who are suffering from diseases; although the fluid restoration needs are different in both the cases. Additionally, restoration needs also vary among paediatric, adolescent, adult and geriatric populations as well as in males and females.

There are various factors leading to loss of water and electrolytes from the body;

1. Normal physical conditions such as sweating, exercising, body metabolism (respiration, heart muscle contractionetc.)
2. Disease conditions such as fever, flu, common cold, heat related illness, Upper Respiratory Tract Infection (URTI), special fevers (like dengue, malaria, typhoid and chikungunya) etc.
3. Iatrogenic conditions like minor surgeries, blood donation etc. For a faster recovery from illness, it is critical to regain/rebalance the lost water, electrolytes and energy from the body. The process of recovery from an illness is accelerated when the main therapy is supplemented with restoration fluid as an adjuvant. The amount and dosage of restoration fluid should be clearly prescribed similar to anyother drug.

There is no evidence showing that consumption of up to 1 cola drink (200 ml)/day can be linked to any metabolic syndrome. However, chronic consumption of cola-beverages, either sucrose-or artificially-sweetened cola, may lead to human metabolic syndrome. It has also been observed that consumption of alcohol above 6 Gms has no medicinal relaxation value.

The sugar limits present in various food items and fluids are;

1. ORS: 2%
2. Sports drink, colas, energy drinks, energy drinks with electrolytes <12%
3. Indian traditional sweets ~30%
4. Indian sweets with sugar syrup (chashni) ~50%

An ideal restoration drink will have the following characteristics:

• Home-made or ready -to-drink
• Non-caffeinated
• Non-alcoholic
• Non-carbonated
• With natural sugar or limited added sugar and electrolytes
• hygienic

• Non-restorative drinks are not recommended ass a substitute for fluids or as a restoration therapy.
• There are two types of restoration therapies:

• Maintenance therapy
• Replacement therapy

• It is recommended to drink an ounce of water for every two pounds of body weight (30ml/Kg body weight)
• Two types of products are used in restoration therapy: ORS-based and non-ORS based
• Non-ORS based restorative fluids comprise of potable safe water with minerals, potable safe water with added energy and electrolytes, and potable safe water with added prebiotic, taurine, calcium, magnesium in specific conditions.
• The best fluid to drink following an exercise session to replace the fluids lost via sweating, should include sodium in the rehydration beverage.
• Restoration sutra: Always prefer hygienic, home-made/ready to drink, non-caffeinated, non-alcoholic, non-carbonated drink with natural or limited quantity of sugar and electrolytes