What is the appropriate intravenous maintenance fluid rate (mL per hour) for a 17‑kg child over a 24‑hour period?

Maintenance Fluid Rate for a 17-kg Child

For a 17-kg child, the standard maintenance intravenous fluid rate is 57 mL/hour over 24 hours, calculated using the Holliday-Segar formula. 1, 2

Calculation Method

Using the Holliday-Segar formula, which remains the standard approach for calculating pediatric maintenance fluid requirements 1, 3:

• First 10 kg: 4 mL/kg/hour = 40 mL/hour 1, 2
• Next 7 kg (10-17 kg): 2 mL/kg/hour = 14 mL/hour 1, 2
• Total: 40 + 14 = 54 mL/hour 1, 2

This translates to approximately 1,296 mL per 24 hours (54 mL/hour × 24 hours). 1

Recommended Fluid Composition

Use isotonic fluids (sodium 130-154 mEq/L) with 2.5-5% dextrose as the standard maintenance solution. 1, 3 Balanced isotonic crystalloids such as lactated Ringer's or PlasmaLyte are preferred over 0.9% NaCl to avoid hyperchloremic acidosis and modestly shorten hospital length of stay. 1

• Add potassium supplementation based on clinical status and regular monitoring to prevent hypokalemia 1, 3
• Include glucose to prevent hypoglycemia, with at least daily blood glucose monitoring 1, 3

Clinical Adjustments Required

The calculated rate must be adjusted based on specific clinical conditions:

Reduce to 65-80% of calculated volume (35-43 mL/hour):

• High-risk ADH secretion states (pneumonia, CNS infection, postoperative, dehydration) 1, 3
• Mechanical ventilation 1
• Temperature-controlled environments 1

Reduce to 50-60% of calculated volume (27-32 mL/hour):

• Renal failure 1, 3
• Heart failure or hepatic failure 1, 3

Increase above calculated volume:

• Fever, hyperventilation, hypermetabolism 1
• Ongoing gastrointestinal losses 1

Total Fluid Accounting

The maintenance rate must include ALL fluid sources, not just the primary IV line: 1, 3

• IV maintenance fluids
• Blood products
• All IV medications (infusions and boluses)
• Arterial and venous line flush solutions
• Enteral intake

Replacement fluids for acute losses or massive transfusion are excluded from this calculation. 1

Monitoring Requirements

Reassess at least daily for: 3, 1

• Fluid balance and clinical status
• Serum sodium levels (to detect hyponatremia)
• Signs of fluid overload or dehydration

Critical Safety Points

Avoid hypotonic fluids (sodium <130 mEq/L) as they are associated with fatal hyponatremic encephalopathy. 1, 4 The traditional use of hypotonic maintenance fluids based on the original Holliday-Segar recommendations is no longer appropriate for hospitalized children, who often have elevated ADH levels and decreased urinary output. 5, 4

Account for "hidden" fluid sources from medications and line flushes to prevent inadvertent fluid overload, which can prolong mechanical ventilation and increase length of stay. 1, 3

Do not continue the same rate without reassessment if the child develops oliguria, fluid overload, or changing clinical conditions. 1, 3