Maintenance Fluid Requirements for a 1-Year-Old Child
For a 1-year-old child, maintenance fluid should be provided at 80-120 mL/kg/day using an isotonic solution (Na 140 mmol/L) rather than hypotonic fluids to reduce the risk of hospital-acquired hyponatremia. 1, 2
Fluid Volume Calculation
The Holliday-Segar formula remains the standard method for calculating maintenance fluid requirements in children:
- For a 1-year-old (typically weighing between 8-12 kg):
- 100 mL/kg/day for the first 10 kg
- Example: For a 10 kg child = 1000 mL/day (or 42 mL/hour)
This aligns with the recommended range of 80-120 mL/kg/day for 1-2 year-old children according to current guidelines 1, 2.
Fluid Composition
- Solution type: Isotonic solution (Na 140 mmol/L) is strongly recommended over traditional hypotonic solutions 1, 2
- Electrolyte content:
- Sodium: 1-3 mmol/kg/day
- Potassium: 1-3 mmol/kg/day
- Chloride: 2-4 mmol/kg/day 1
Important Clinical Considerations
Fluid requirements must be adjusted based on the child's clinical condition:
For children at risk of increased ADH secretion, fluid restriction to 65-80% of calculated maintenance volume is recommended 2
More severe restriction (50-60% of calculated volume) may be needed for children with edematous states 2
Monitoring Parameters
Regular monitoring is essential when administering maintenance fluids:
- Daily assessment of fluid balance and clinical status
- Regular monitoring of serum electrolytes
- Monitoring of serum glucose to prevent hypo/hyperglycemia 2
Common Pitfalls to Avoid
- Using hypotonic fluids, which increase the risk of hyponatremia and potentially fatal hyponatremic encephalopathy 1, 2, 3
- Failure to adjust fluid rates in children with conditions affecting fluid balance
- Not accounting for "fluid creep" from medications and other IV infusions 2
The evidence strongly supports using isotonic balanced solutions for maintenance IV fluids in hospitalized children, as multiple studies have demonstrated a lower risk of developing hyponatremia compared to hypotonic solutions, regardless of the rate of administration 1, 2, 3.