From the Guidelines
To calculate fluid maintenance, use the Holliday-Segar method: 100 mL/kg for the first 10 kg of body weight, plus 50 mL/kg for the next 10 kg, plus 25 mL/kg for each additional kg above 20 kg, as recommended by the most recent guidelines 1. This method provides a straightforward way to estimate daily fluid requirements for children and infants beyond the neonatal period.
- For the first 10 kg of body weight, the requirement is 100 mL/kg/day, which translates to 4 mL/kg/hour.
- For the next 10 kg (from 11-20 kg), the requirement is an additional 50 mL/kg/day, or 2 mL/kg/hour.
- For each kilogram above 20 kg, the requirement is an additional 25 mL/kg/day, or 1 mL/kg/hour. For example, a 30 kg child would need (100 × 10) + (50 × 10) + (25 × 10) = 1000 + 500 + 250 = 1750 mL/day. It's essential to note that these calculations provide baseline maintenance needs and may need to be adjusted based on individual clinical conditions, such as fever, hyperventilation, or excessive sweating, as well as the presence of specific medical conditions that may affect fluid balance 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY: ... Average normal adult daily requirements range from two to three liters (1 to 1. 5 liters each for insensible water loss by perspiration and urine production).
The fluid maintenance is 2 to 3 liters per day for an average normal adult, with 1 to 1.5 liters for insensible water loss by perspiration and urine production, as stated in the dextrose (PO) drug label 2.
From the Research
Fluid Maintenance Calculation
To calculate the fluid maintenance, several factors need to be considered, including the type of fluid, the patient's condition, and the clinical setting.
- The choice of maintenance fluid is crucial, with options including crystalloid solutions such as isotonic saline or balanced salt solutions, and dextrose solutions 3, 4, 5, 6.
- Crystalloid solutions are often preferred for maintenance fluid therapy due to their ability to provide essential electrolytes and fluids without causing fluid overload 3, 5.
- Dextrose solutions, on the other hand, may exacerbate cellular ischemic damage and are not recommended for resuscitating hypotensive patients 3.
- The use of balanced crystalloids versus isotonic saline in critically ill patients has been studied, with no significant difference found in clinical outcomes such as acute kidney injury, in-hospital mortality, and intensive care unit mortality 5.
- In pediatric patients, maintenance fluid therapy with saline, dextrose-supplemented saline, or lactated Ringer solution has different effects on metabolic balance, highlighting the need for personalized fluid therapy 6.
Key Considerations
- The type of fluid used for maintenance therapy can impact patient outcomes, with crystalloid solutions generally preferred over dextrose solutions 3, 4, 5.
- Patient-specific factors, such as underlying disease and clinical condition, should be taken into account when selecting a maintenance fluid 3, 4, 6.
- Regular monitoring of patient response to fluid therapy is essential to ensure optimal outcomes and minimize potential adverse effects 4, 6.