May 2, 2020

The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Accounting for deficits when determining the fluid. Maintenance fluid therapy as defined by Holliday and The formula assumes normal renal function . Holliday/Segar formula of ml/kg body weight (BW). The Maintenance Fluid Calculation for Children helps to determine the daily volume of fluids needed based on the weight of a child. This calculation also.

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The amount of fluid in phase III is equivalent to two thirds of the daily maintenance plus the remaining deficit. Monitoring Parameters for Parenteral Fluid Therapy. The opposite problem may happen after a patient has been given multiple fluid boluses. By continuing to use this website, you agree to their use. The deficit fluid volume should be added to hplliday maintenance fluid volume needed for 48 hours, and the total should be administered over 48 hours.

Patients suffering from fever, burn injuries, 9 hypermetabolic states, pain, asthma, and increased intestinal losses may all have elevated maintenance fluid requirements.

Ensuring that the patient is not getting an excessive amount of fluids in medications can help prevent overhydration. In both of these cases, symptoms of hyponatremia were explained as side effects of drugs. Sear, while the Holliday-Segar method actually estimates kilocalories lost, it is estimated that a loss of 1 kilocalorie requires 1 mL in replacement, so the kilocalorie estimate is an efficient target for fluid requirements. Holliday and Segar collated information from a number of studies, including their own, and concluded the following: Requirements for children are higher than those for adults for multiple reasons.

Maintenance Fluid Requirements

The first parameter for monitoring is oral intake Table 6. Author information Copyright and License information Disclaimer.

Generally speaking, the oral route for providing fluid therapy is preferred as soon as it is clinically indicated, as any intravenous administration brings with it the risk of infection.


One clinical sign of dehydration which can be of use is weight loss. Applying the principles of pharmacokinetics to a working knowledge of fluid and electrolytes in children can help pharmacists individualize medication therapy to the specific needs of the patient. Organizing fluid therapy into maintenance, deficit, and replacement requirements, and then monitoring the patient for response to therapy makes fluid therapy manageable.

Hypotonic versus isotonic saline in hospitalized children: However, there has been recent attention in the literature to the potential for causing hyponatremia when using 0. Index of Core Concept Chapters.

These medications include insulin and beta adrenergic agonists such as albuterol. Maintenance fluids are given to compensate for ongoing losses and are required for all patients. Patients with hypotonic or isotonic dehydration are given fluids using the same technique to calculate fluid amount and rate Table 5.

Data from Rusconi F, et al. Each of these methods, while providing a reasonable estimate of maintenance fluids, cannot account for the physiologic changes that occur in hospitalized children. This formula relates water loss to the caloric expenditure. That is, for every kilocalories burned, the patient utilizes ml. Clinical signs of dehydration should be taken into consideration first, as they can provide useful insight into the fluid needs of the patient.

The most commonly used technique to calculate maintenance fluids for children is the Holliday-Segar method Table 2.

Hospitalized children frequently have elevated fluid requirements due to their illness. Rehydration is divided into three phases.


What will be the maintenance fluid requirement for a child weighing 6kg? Isotonic fluids are used because they provide rapid volume expansion in the plasma and extracellular fluid.

Maintenance electrolyte requirements must be taken into account, with particular attention paid to sodium requirements, as recent evidence suggests that sodium needs in hospitalized children are higher than originally thought. Later, seizures were misperceived as fidgeting from pain.

Clinical Signs of Dehydration.

Thanks Nurse Hassan Like Like. A case for using isotonic saline.


The diagram below is taken from their original publication “The maintenance need for water in parenteral fluid therapy”, Pediatrics You are commenting using your WordPress. The patient became hyponatremic after receiving ethacrynic acid, and it was unclear whether the patient received the subsequent order for a sodium chloride infusion. Accounting for deficits when determining the fluid infusion rate is an important factor in treating dehydrated patients; deficit fluid is generally administered over the first 24 hours of hospitalization.

Abstract Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. First, the higher metabolic rate of children requires a greater caloric expenditure, which translates into higher fluid requirements.

For this reason, when calculating maintenance fluids, pharmacists must always keep in mind factors that may affect fluid balance and changed needs. Hydration status can have an important impact on drug therapy, and should be considered when using medications with large volumes of distribution.

The approach to patients with hypertonic dehydration is quite different, due to the hyperos-molar state of their circulating blood. The management of acute gastroenteritis in young children. A child weighing 14kg was rushed to the emergency department. Most dehydrated patients have an isotonic dehydration. To find out more, including how to control cookies, see here: Sensible losses, which include urine output and fecal water, make up the majority of ongoing losses, with additional contributions from insensible losses such as respiration and perspiration.

Patients who are not allowed anything by mouth for a short time, such as for an uncomplicated surgery, and for whom only maintenance fluids are required, may have their fluids decreased and eventually stopped once they tolerate oral hydration. Calculate the daily maintenance fluid of the child.