Maintenance Parenteral Fluid Rate for a 64.5kg Pediatric Patient
For a 64.5kg pediatric patient requiring maintenance parenteral fluids, administer 1.5-2 mL/kg/min (2.2-2.9 g/kg/day) of glucose during the stable phase, which translates to approximately 97-129 mL/hour of fluid containing dextrose. 1
Weight-Based Fluid Calculation
- A 64.5kg patient falls into the ">45 kg" category for parenteral nutrition guidelines 1
- During the stable phase (when the patient is stable on or can be weaned from vital organ support), the glucose delivery rate should be 1-2 mg/kg/min (1.4-2.9 g/kg/day) 1
- This translates to approximately 1.5-2 mL/kg/min of total fluid volume when using standard dextrose concentrations 1
Practical Fluid Rate Calculation
- For a 64.5kg patient: 97-129 mL/hour (approximately 2300-3100 mL/day) 1
- This assumes the patient is in a stable clinical phase, not acutely ill or in recovery 1
Phase-Based Adjustments
If the patient is in different clinical phases, adjust accordingly:
- Acute phase (requiring vital organ support): 0.5-1 mg/kg/min glucose (0.7-1.4 g/kg/day), which is approximately 32-65 mL/hour 1
- Recovery phase (mobilizing): 2-3 mg/kg/min glucose (2.9-4.3 g/kg/day), which is approximately 129-194 mL/hour 1
Glucose Concentration Considerations
- The maximum rate of glucose oxidation should not be exceeded to avoid complications 1
- For children, the maximum glucose oxidation rate varies by age and clinical status, but generally should not exceed 12 mg/kg/min (17.3 g/kg/day) 1
- For a 64.5kg patient, this upper limit would be approximately 774 mL/hour, which is well above maintenance needs 1
Electrolyte Composition
Standard maintenance electrolytes should be included:
- Sodium: 2-3 mmol/kg/day for stable patients 2
- Potassium: 1.5-3 mmol/kg/day 2
- Chloride: Slightly lower than the sum of sodium and potassium (Na + K - Cl = 1-2 mmol/kg/day) to prevent metabolic acidosis 2
Critical Monitoring Parameters
- Monitor blood glucose levels regularly to ensure glucose delivery does not exceed oxidation capacity 1
- Track daily weight and fluid balance 2
- Monitor serum electrolytes, particularly in the first 48-72 hours 2
- Assess for signs of fluid overload (pulmonary edema, hepatomegaly) 1
Common Pitfalls to Avoid
- Do not use the acute phase rate for stable patients, as this will result in inadequate nutrition and potential catabolism 1
- Avoid excessive glucose administration beyond oxidation capacity, which can lead to hyperglycemia and lipogenesis 1
- Do not ignore the clinical phase when calculating fluid rates—a patient on mechanical ventilation requires different rates than an ambulatory patient 1
- Avoid high chloride loads by using balanced electrolyte solutions to prevent hyperchloremic metabolic acidosis 2