Dehydration in Tropical Fevers: Rethinking Fluid and Electrolyte Replacement

Tropical fevers, including dengue, malaria, typhoid, chikungunya, leptospirosis, and scrub typhus, impose a substantial and growing public health burden in the tropical and subtropical regions, particularly the Indian subcontinent. Climate change, monsoon season, and inadequate sanitation further exacerbate transmission dynamics and outbreak patterns. Dehydration represents a critical yet frequently underrecognized complication of these infections. It is attributed to high-grade fever, vomiting, excessive sweating, decreased oral intake, and pathophysiological mechanisms, such as plasma leakage in dengue, hemolysis in malaria, and gastrointestinal losses in typhoid. Electrolyte disturbances, specifically hyponatremia, hypokalemia, and hypochloremia, contribute to the severity of these conditions and likelihood of multi-organ failure. Inadequate hydration amplifies underlying physiological dysfunction, including hemoconcentration, hypovolemic shock, acute kidney injury, and cardiovascular compromise, thereby increasing hospitalization rates, morbidity, and mortality. This review explores the disease-specific hydration challenges across diverse tropical fevers and evaluates the current strategies for effective fluid management. The World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and national guidelines recommend oral rehydration therapy, formulated with optimized sodium and glucose concentrations to promote rehydration through facilitation of the intestinal sodium-glucose co-transporter (SGLT1) mechanism for management of ambulatory and mild-to-moderate cases. Its efficacy in symptom relief, minimizing intravenous fluid requirements, and accelerating clinical recovery is well established. However, individualized and careful calibration of fluid management remains essential to prevent fluid overload and other related complications. Thus, integrating standardized, evidence-based hydration protocols into routine clinical practice holds the potential to be a practical and cost-effective strategy for managing tropical infection in India and other regions with similar climatic and epidemiological settings.