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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Fluid and electrolyte therapy is an essential component of the care of hospitalized children, and a thorough understanding of the changing requirements of growing children is fundamental in appreciating the many important pharmacokinetic changes that occur from birth to adulthood. Clinical Signs of Dehydration. Isotonic fluids are used because they provide rapid volume expansion in the plasma and extracellular fluid. To find out more, including how to control cookies, see here: Support Center Support Center.

The opposite problem may happen after a patient has been given multiple fluid boluses. In phase I, a bolus of fluid is given in order to restore blood volume to ensure adequate perfusion of critical organs, such as the brain.

This article has been cited by other articles in PMC. The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Bolus fluids should be isotonic; either normal saline or lactated ringers solution is used at a volume of 20 mL per kg, given over 60 minutes. Thus, 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.

You are commenting using your Facebook account. In both of these cases, symptoms of hyponatremia were explained as side effects of drugs. Deficit fluids, like maintenance fluids, are most easily handled by approaching the needs of the patient in a systematic manner.


Hospitalized children frequently have elevated fluid requirements due to their illness. In addition, children, especially fofmula, have higher respiratory rates, 8 and this equates to higher insensible losses from the respiratory tract Table 1. The degree of dehydration calculated should always be compared to the clinical signs, which may be better indicators of hydration status and are also especially useful when a pre-illness weight is unknown.

Pediatric Fluid and Electrolyte Therapy

By the time a patient is out of the neonatal period, the usual dose of gentamicin is 2. Monitoring patients’ weights can be especially important, particularly in infants, as younger patients tend to present with more significant weight loss when dehydrated.

As mentioned previously, the large percentage of total body water in neonates has a great impact on therapy with water-soluble drugs, such as aminoglycosides. Even though it is correct to think about fluid requirements on a hour basis, the delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate. Recently, two pediatric deaths from hyponatremia have been reported in post-operative situations.

In this situation, the volume of distribution may temporarily be increased, and thus a standard dose may lead to subtherapeutic serum concentrations. Holliday segar method is a widely acceptable method of calculating maintenance fluid, especially in children. Ensuring that the patient is not getting an excessive amount of fluids in medications can help prevent overhydration. Fluid, electrolytes, and acid-base homeostasis. It can be given by intravenous routes or oral routes if patient can tolerate orally or both.

This means that for every kcal burned, the patient utilizes ml of fluid. Maintenance fluids xegar given to compensate for ongoing losses and are required for all patients. When considering fluid requirements in hospitalized children, potential increased or decreased needs should always be kept in mind.

Other methods of estimating maintenance fluid requirements exist, including those using body surface area and basal calorie requirements. Body water compartments in children: Each of these examples demonstrates a situation where there is an ongoing loss which would not be met by administering only maintenance fluids.


Organizing fluid needs into maintenance, deficit, formua replacement therapy can provide a systematic, understandable approach to determining fluid therapy. The potential for hyponatremia or hypernatremia emphasizes the need for close monitoring of serum sodium in hospitalized children receiving intravenous fluid therapy, particularly in the post-operative period.

Most dehydrated patients have an isotonic dehydration. Caloric expenditure, and therefore the water requirement, for the hospitalized patient can be estimated from the nomogram shown below. When monitoring patients who are being treated with maintenance and deficit fluids for dehydration, the most important monitoring parameters are those which defined the dehydration in the first place, such as skin turgor, urine output, and thirst see Table 4 for a complete list.

Jospe N, Forbes G. Each of these methods, while providing a reasonable estimate of maintenance fluids, cannot account for the physiologic changes that occur in hospitalized children.


Relation of electrolyte disturbances to cardiac arrhythmias. The changes that take place as a child grows have a great effect on fluid requirements, making special attention to fluid therapy essential in pediatric pharmacotherapy. A case for using isotonic saline. Urine specific gravity can also be used to assess hydration status. Footnotes Data from Rusconi F, et al. Hydration status can have an important impact on drug therapy, and should be considered when using medications with large volumes of distribution.