IV Fluid Rate for a 29kg Pediatric Patient
For a 29kg child requiring maintenance IV fluids, administer isotonic balanced crystalloid solution (such as 0.9% NaCl with 5% dextrose) at 65-80% of the Holliday-Segar calculation, which equals approximately 1000-1200 mL/day (42-50 mL/hour), with daily electrolyte monitoring. 1
Calculation Method
Traditional Holliday-Segar Formula:
- For a 29kg child: 1000 mL (for first 10kg) + 500 mL (for second 10kg) + 180 mL (for remaining 9kg) = 1680 mL/day (70 mL/hour) 1
Recommended Restricted Rate:
- Apply 65-80% restriction: 1092-1344 mL/day (approximately 45-56 mL/hour) 1
- This restriction prevents hyponatremia and fluid overload in acutely ill hospitalized children 1
Fluid Composition
Use isotonic balanced crystalloid solutions with appropriate glucose supplementation:
- Typical composition: 0.9% NaCl with 5% dextrose 1
- Add potassium 20-40 mEq/L once renal function confirmed and serum potassium known (use 2/3 KCl and 1/3 KPO4) 1
- Avoid hypotonic solutions in hospitalized children due to significant hyponatremia risk 1
Critical Monitoring Requirements
Daily reassessment is mandatory:
- Monitor electrolytes (especially sodium) at least daily 1
- Calculate total fluid intake including all IV fluids, blood products, IV medications, line flushes, and enteral intake to prevent "fluid creep" 1
- Assess clinical status and fluid balance daily 1
Special Clinical Scenarios
For specific conditions, adjust rates accordingly:
- Heart failure, renal failure, or hepatic failure: Restrict to 50-60% of Holliday-Segar (840-1008 mL/day or 35-42 mL/hour for 29kg) 1
- Shock resuscitation: Use 20 mL/kg boluses (580 mL for 29kg) over 5-10 minutes, repeatable up to 60 mL/kg in first hour based on response 2, 1
- DKA: Administer 2-3 L/m²/day of one-quarter normal saline with 5% dextrose 1
Common Pitfalls to Avoid
- Do not use full Holliday-Segar rates in acutely ill children with elevated ADH secretion, as this leads to fluid overload and hyponatremia 1
- Do not use hypotonic solutions for routine maintenance in hospitalized children 1
- Do not delay monitoring—check electrolytes and fluid balance daily at minimum, more frequently in unstable patients 1
- Avoid 0.9% saline without glucose for maintenance fluids, as it can cause hyperchloremic acidosis and does not prevent hypoglycemia 2