What are the recommended maintenance intravenous (IV) fluids for a 2-year-old male?

Maintenance IV Fluids for a 2-Year-Old Male

For a 2-year-old male, maintenance IV fluids should be isotonic balanced solutions (such as PlasmaLyte) with appropriate dextrose and potassium, administered at a rate of 80-120 ml/kg/day (based on the Holliday-Segar formula). 1, 2

Fluid Volume Calculation

For a 2-year-old male (assuming average weight around 12-13 kg):

• First 10 kg: 100 ml/kg/day = 1000 ml/day
• Additional 2-3 kg: 50 ml/kg/day = 100-150 ml/day
• Total: 1100-1150 ml/day (approximately 45-48 ml/hour)

This can be calculated using the Holliday-Segar formula 2:

• First 10 kg: 100 ml/kg/day (4 ml/kg/hour)
• Second 10 kg: 50 ml/kg/day (2 ml/kg/hour)
• Each additional kg: 25 ml/kg/day (1 ml/kg/hour)

Fluid Composition

Tonicity

• Use isotonic solutions (sodium concentration 135-144 mEq/L) to reduce the risk of hyponatremia 2, 1
• Balanced solutions (like PlasmaLyte) are preferred over unbalanced solutions (like normal saline) to slightly reduce length of stay 2, 1

Additives

1. Dextrose: Include dextrose (typically 5%) to prevent hypoglycemia 2, 1

   • Monitor blood glucose at least daily

2. Potassium: Add 1-3 mmol/kg/day of potassium chloride 2, 3

   • Only add potassium after confirming normal renal function and urine output
   • Monitor potassium levels regularly
   • Do not exceed 10 mEq/hour in concentration less than 30 mEq/L 3

3. Other electrolytes: Routine supplementation of magnesium, calcium, and phosphate is not recommended without evidence of deficiency 2, 1

Special Considerations

Fluid Restriction

• In acutely ill children at risk of increased ADH secretion, restrict maintenance fluid volume to 65-80% of the calculated volume 2, 1
• In children with edematous states (heart failure, renal failure, hepatic failure), restrict to 50-60% of the calculated volume 2, 1

Monitoring

• Monitor electrolytes, especially sodium, at least daily 1
• Track fluid balance and daily weights 2
• Reassess the child's clinical status at least daily 2

Common Pitfalls to Avoid

1. Using hypotonic solutions: Hypotonic solutions (0.18% or 0.45% NaCl) increase the risk of hospital-acquired hyponatremia 4, 5

   • Studies show that hospital-acquired hyponatremia occurs in up to 12.5% of children receiving hypotonic fluids 4

2. Failing to consider total fluid intake: Consider all sources of fluid including IV medications, line flushes, and enteral intake to prevent "fluid creep" 2

3. Not transitioning to enteral fluids when possible: The enteral or oral route should be prioritized when tolerated to reduce complications 2

4. Using lactate buffer solutions in patients with liver dysfunction: This can lead to lactic acidosis 2

5. Inadequate monitoring: Failure to monitor electrolytes and fluid balance can lead to complications 1

Remember that isotonic fluids are now the standard of care for maintenance IV fluids in children outside the neonatal period, as recommended by the American Academy of Pediatrics and the European Society of Pediatric and Neonatal Intensive Care 1, 5.