What is the appropriate rate of intravenous (IV) fluids for a 30 kilogram (kg), 14-year-old child?

IV Fluid Rate for a 30 kg, 14-Year-Old Child

For a 30 kg, 14-year-old hospitalized child, administer isotonic fluids (D5 0.9% NaCl with appropriate electrolytes) at 1300-1600 mL/day (54-67 mL/hour), which represents 65-80% of the traditional Holliday-Segar calculation to prevent hyponatremia and fluid overload. 1

Calculation Method

Traditional Holliday-Segar Formula (Full Rate)

• First 10 kg: 100 mL/kg/day = 1000 mL/day
• Second 10 kg: 50 mL/kg/day = 500 mL/day
• Remaining 10 kg: 20 mL/kg/day = 200 mL/day
• Total = 1700 mL/day (71 mL/hour) 1

Recommended Restricted Rate for Hospitalized Children

The American Academy of Pediatrics recommends using 65-80% of the Holliday-Segar calculation for acutely and critically ill pediatric patients to prevent complications. 1 This translates to:

• 65% of 1700 mL = 1105 mL/day (46 mL/hour)
• 80% of 1700 mL = 1360 mL/day (57 mL/hour)
• Practical range: 1300-1600 mL/day (54-67 mL/hour) 1

Fluid Composition

Use isotonic balanced crystalloid solutions with 5% dextrose (D5 0.9% NaCl) as the base maintenance fluid. 2, 1 The historical practice of using hypotonic fluids has been abandoned due to significant hyponatremia risk. 2, 3

Electrolyte Additions

• Add potassium 20-40 mEq/L once renal function is confirmed and serum potassium is known (use 2/3 KCl and 1/3 KPO4) 1
• Isotonic saline (0.9% NaCl) contains 154 mEq/L each of sodium and chloride 2
• Provide sufficient glucose (typically 5% dextrose) guided by at least daily blood glucose monitoring 1

Critical Adjustments for Specific Conditions

If Heart Failure, Renal Failure, or Hepatic Failure Present

Restrict maintenance fluid to 50-60% of Holliday-Segar volume (850-1020 mL/day or 35-43 mL/hour for this 30 kg child) 1

If Shock or Severe Dehydration

Administer isotonic crystalloid boluses of 20 mL/kg (600 mL for this patient) over 5-10 minutes, which can be repeated up to 60 mL/kg in the first hour based on clinical response. 1 This is separate from maintenance fluids.

Monitoring Requirements

Reassess patients receiving IV maintenance fluids at least daily for fluid balance and clinical status, with regular monitoring of electrolytes (especially sodium). 1 For a 14-year-old, this is particularly important as older children may have different metabolic needs than younger children. 2

Calculate total daily fluid intake including all IV fluids, blood products, IV medications, arterial/venous line flushes, and enteral intake to prevent "fluid creep." 1 Research shows that fluid creep (fluids administered as drug vehicles) can contribute 34-56% of total fluid intake and significantly increase sodium/chloride load. 4

Critical Pitfalls to Avoid

• Do not use hypotonic solutions (0.45% NaCl or less) for routine maintenance as they significantly increase hyponatremia risk, which can cause fatal hyponatremic encephalopathy in children 2, 3, 5
• Do not apply full Holliday-Segar maintenance rates to acutely ill children with elevated ADH secretion (from pain, nausea, stress, postoperative state, pneumonia, meningitis), as this leads to fluid overload and hyponatremia 2, 1
• Do not delay monitoring—check electrolytes and fluid balance daily at minimum, more frequently in unstable patients 1
• Recognize that hospitalized children have vastly different energy expenditure than healthy children (closer to 50-60 kcal/kg/day basal metabolic rate versus the 100 kcal/kg/day used in original Holliday-Segar calculations) 2, 6