Maintenance Fluid Calculation for a 2-Year-Old Child Weighing 13.5 kg
For a healthy 2-year-old weighing 13.5 kg, provide 1175 mL per day (approximately 49 mL/hour) of isotonic crystalloid solution for maintenance hydration. 1, 2
Calculation Using the Holliday-Segar Formula
The Holliday-Segar formula is the standard method for calculating maintenance fluid requirements in pediatric patients beyond the neonatal period 3, 1, 2:
- First 10 kg: 100 mL/kg/day = 1000 mL/day
- Next 3.5 kg: 50 mL/kg/day = 175 mL/day
- Total: 1175 mL/day (or approximately 49 mL/hour) 1, 2
Alternatively, this can be calculated hourly as 4 mL/kg/h for the first 10 kg plus 2 mL/kg/h for the remaining 3.5 kg, yielding the same result 2.
Fluid Type Selection
Use only isotonic crystalloid solutions (0.9% normal saline or lactated Ringer's) for maintenance hydration. 1, 2 Hypotonic solutions are strongly discouraged because they significantly increase the risk of iatrogenic hyponatremia and potentially fatal hyponatremic encephalopathy 1, 2. The recommended sodium concentration is 140 mmol/L 2.
Electrolyte Requirements
For maintenance parenteral fluids in this age group, provide 3, 2:
- Sodium: 1-3 mmol/kg/day (13.5-40.5 mmol/day)
- Potassium: 1-3 mmol/kg/day (13.5-40.5 mmol/day)
- Chloride: 2-4 mmol/kg/day (27-54 mmol/day)
Critical Clinical Considerations
When to Modify the Standard Calculation
Reduce fluid volumes to 75-90 mL/kg/day (approximately 1012-1215 mL/day for this child) if any of the following conditions are present 1, 2:
- Cardiac disease or heart failure
- Renal impairment or acute kidney injury
- Respiratory distress or chronic lung disease
- Risk of fluid overload
Signs Requiring Immediate Fluid Cessation
Stop fluid administration immediately if any of these signs develop 1:
- Pulmonary rales or crackles on auscultation
- Hepatomegaly
- Progressive peripheral edema
- Increased work of breathing or worsening oxygenation
- Gallop rhythm on cardiac examination
These indicate fluid overload and necessitate transition to inotropic support rather than continued fluid administration 1.
Resuscitation vs. Maintenance
This calculation applies only to maintenance hydration in a stable child. If the child presents with dehydration or shock, different protocols apply 1, 2:
- Mild dehydration: 50 mL/kg over 2-4 hours
- Moderate dehydration: 100 mL/kg over 2-4 hours
- Severe dehydration/shock: 20 mL/kg boluses of isotonic crystalloid, repeated as needed up to 60 mL/kg in the first hour with reassessment after each bolus
Common Pitfalls to Avoid
- Never use hypotonic fluids for maintenance in hospitalized children, as this dramatically increases hyponatremia risk 1, 2
- Do not exceed 60 mL/kg in the first hour during resuscitation without clinical reassessment, as higher volumes are associated with worse outcomes 1, 2
- Monitor closely for fluid overload in children with cardiac or renal disease, adjusting rates based on clinical response 2
- Do not rely on blood pressure alone to assess perfusion status, as hypotension is a late finding in pediatric patients 1