What is the appropriate dosage of intravenous (IV) fluids for a 4-5 year old child weighing 17 kilograms (kg)?

IV Fluid Dosage for a 17 kg Child

For a 17 kg child requiring maintenance IV fluids, administer isotonic balanced crystalloid solution (such as 0.9% NaCl with 5% dextrose) at a rate of 1,050 mL per 24 hours (approximately 44 mL/hour), which represents 65-80% of the traditional Holliday-Segar calculation to prevent hyponatremia and fluid overload. 1

Calculating the Maintenance Rate

The traditional Holliday-Segar formula for a 17 kg child calculates as follows: 1

• First 10 kg: 100 mL/kg/day = 1,000 mL/day
• Remaining 7 kg: 50 mL/kg/day = 350 mL/day
• Total = 1,350 mL/day (56 mL/hour)

However, current guidelines recommend restricting this to 65-80% of the calculated volume for acutely and critically ill children to prevent hyponatremia associated with elevated antidiuretic hormone (ADH) secretion. 2, 1

Practical dosing:

• 65% restriction: 878 mL/day (37 mL/hour)
• 80% restriction: 1,080 mL/day (45 mL/hour)
• Recommended range: 880-1,080 mL/day (37-45 mL/hour) 2, 1

Fluid Composition

Use isotonic balanced crystalloid solutions rather than hypotonic fluids: 2, 1, 3

• 0.9% NaCl (normal saline) with 5% dextrose is the standard choice 1, 4
• Balanced solutions (such as lactated Ringer's with dextrose) are preferred when available to reduce length of stay 2

Add potassium once renal function is confirmed: 1

• 20-40 mEq/L of potassium (using 2/3 KCl and 1/3 KPO4)
• Only after urine output is established and serum potassium is known

Glucose supplementation is essential: 2, 1

• 5% dextrose concentration is typical
• Monitor blood glucose at least daily to prevent both hypoglycemia and hyperglycemia 2

Critical Pitfalls to Avoid

Never use hypotonic solutions (0.2% or 0.45% NaCl) for routine maintenance in hospitalized children, as they significantly increase the risk of hospital-acquired hyponatremia, which can cause permanent neurological injury or death. 1, 3, 5, 4 Studies show that 18.5% of children receiving hypotonic fluids develop hyponatremia. 5

Do not apply full Holliday-Segar rates to acutely ill children, as most hospitalized children have elevated ADH secretion from illness, pain, nausea, or stress, leading to free water retention and hyponatremia if full maintenance rates are given. 2, 1, 4

Account for all fluid sources when calculating total daily intake, including IV medications, line flushes, blood products, and enteral intake to prevent "fluid creep" and cumulative positive fluid balance. 2, 1

Monitoring Requirements

Reassess the child at least daily: 2, 1

• Fluid balance (intake and output documentation)
• Clinical status (perfusion, work of breathing, hepatomegaly, edema)
• Electrolytes, especially sodium levels
• Blood glucose levels

More frequent monitoring is required for unstable patients or those at higher risk of complications. 1

Special Circumstances

For fluid resuscitation in shock (separate from maintenance fluids): 2, 1

• Administer 20 mL/kg boluses of isotonic crystalloid over 5-10 minutes
• Can repeat up to 60 mL/kg in the first hour based on clinical response
• This is in addition to maintenance fluid calculations

For children with heart failure, renal failure, or hepatic failure: 2, 1

• Restrict maintenance fluids to 50-60% of Holliday-Segar volume (approximately 675-810 mL/day for this 17 kg child)
• Monitor even more closely for fluid overload

The evidence strongly supports isotonic fluids over hypotonic solutions regardless of administration rate, with the most benefit seen in the first 24 hours of therapy across all ages and illness severities. 3, 5