Maintenance IV Fluid Rate for an 8-Year-Old Child
For an 8-year-old child (typically 20-30 kg), administer isotonic maintenance fluids at 60 mL/kg/day (approximately 60-70 mL/hour for a 25 kg child), using the Holliday-Segar formula: 100 mL/kg/day for the first 10 kg + 50 mL/kg/day for the second 10 kg, which equals 1,500 mL/day or approximately 60 mL/hour. 1, 2, 3
Calculating the Rate Using Holliday-Segar Formula
The standard calculation for an 8-year-old follows this stepwise approach: 4, 1, 3
- First 10 kg: 100 mL/kg/day (or 4 mL/kg/hour) = 1,000 mL/day 4, 3
- Second 10 kg (for children 10-20 kg): Add 50 mL/kg/day (or 2 mL/kg/hour) 4, 3
- Above 20 kg: Add 25 mL/kg/day (or 1 mL/kg/hour) for each additional kg 4, 3
For example, a 25 kg child requires: 1,000 mL + 500 mL + 125 mL = 1,625 mL/day (approximately 65-70 mL/hour). 3
Mandatory Fluid Composition
Use isotonic fluids (sodium 130-154 mEq/L) exclusively—never hypotonic fluids—as hypotonic solutions have directly caused over 50 cases of neurologic morbidity including 26 deaths in children. 2, 5, 6
The fluid should contain: 1, 2, 3
- Sodium: 130-154 mEq/L (isotonic) 2
- Glucose: 2.5-5% dextrose to prevent hypoglycemia 1, 2, 3
- Potassium: Add based on clinical status and monitoring (typically 20 mEq/L) 1, 2
- Preferred solution: Balanced crystalloids (lactated Ringer's or PlasmaLyte) over 0.9% NaCl to reduce length of stay 1, 2, 3
Critical Volume Adjustments Based on Clinical State
Do not automatically give full calculated maintenance—adjust based on the child's condition: 1, 2, 3
Reduce to 65-80% of calculated volume (approximately 1,040-1,280 mL/day) for: 1, 2, 3
- Pneumonia or respiratory infections
- CNS infections (meningitis, encephalitis)
- Postoperative state
- Mechanical ventilation
- Temperature-controlled environments
- Any condition with increased ADH secretion risk
Reduce to 50-60% of calculated volume (approximately 800-960 mL/day) for: 1, 3
- Renal failure
- Heart failure
- Hepatic failure with edema
Increase above calculated volume for: 3
- Fever
- Hyperventilation
- Hypermetabolism
- Ongoing gastrointestinal losses
Account for ALL Fluid Sources
The calculated maintenance rate must include every fluid source—this is where most errors occur: 1, 2, 3
- IV maintenance fluids
- Blood products
- IV medication infusions and boluses
- Arterial and venous line flushes
- Enteral intake (if any)
Replacement fluids for acute losses or resuscitation boluses are NOT included in maintenance calculations. 3
Mandatory Daily Monitoring
Reassess at least daily: 1, 2, 3
- Serum sodium (most critical—check daily minimum) 1, 2, 3
- Blood glucose (daily minimum) 1, 2, 3
- Serum potassium 1, 2
- Fluid balance and intake/output 1, 2, 3
- Clinical status: weight, perfusion, work of breathing 1, 2, 3
Common Pitfalls to Avoid
Never use hypotonic fluids (sodium <130 mEq/L)—this practice has caused fatal hyponatremic encephalopathy in multiple children. 2, 5
Do not ignore "hidden" fluids from medications, flushes, and blood products—these contribute significantly to total daily intake and commonly cause inadvertent fluid overload. 2, 3
Do not continue full maintenance rates without reassessment in children who develop fluid overload, oliguria, or changing clinical conditions. 2, 3
Avoid fluid overload and cumulative positive fluid balance, which prolongs mechanical ventilation and increases length of stay. 1, 3