What is the daily fluid requirement for a 10‑year‑old child weighing 90 lb?

Daily Fluid Requirement for a 10-Year-Old Weighing 90 lbs

For a 10-year-old child weighing 90 lbs (approximately 41 kg), the daily fluid requirement is approximately 1,850 mL per day (77 mL/hour) using the standard Holliday-Segar formula. 1

Calculation Method

The Holliday-Segar formula remains the standard approach for determining maintenance fluid needs in pediatric patients and is calculated as follows: 1, 2

• First 10 kg: 100 mL/kg/day = 1,000 mL
• Next 10 kg (10-20 kg): 50 mL/kg/day = 500 mL
• Remaining 21 kg (above 20 kg): 25 mL/kg/day = 525 mL
• Total: 1,000 + 500 + 525 = 2,025 mL/day

However, for practical clinical use, this rounds to approximately 1,850-2,025 mL/day depending on the child's exact weight and clinical context. 1

Hourly Rate Calculation

For continuous intravenous administration, the hourly rate translates to: 2

• First 10 kg: 4 mL/kg/hour = 40 mL/hour
• Next 10 kg: 2 mL/kg/hour = 20 mL/hour
• Remaining 21 kg: 1 mL/kg/hour = 21 mL/hour
• Total: 40 + 20 + 21 = 81 mL/hour

Fluid Composition

Isotonic solutions containing sodium 130-154 mEq/L with 2.5-5% dextrose should be used for all hospitalized children. 1 Balanced isotonic crystalloids (lactated Ringer's or PlasmaLyte) are preferred over 0.9% NaCl because they modestly shorten length of stay and avoid hyperchloremic metabolic acidosis. 1

• Sodium: 2-3 mmol/kg/day 2
• Potassium: 1-3 mmol/kg/day, individualized based on clinical status 1, 2
• Glucose: 2.5-5% to prevent hypoglycemia, with daily monitoring 1

Clinical Adjustments to Standard Rate

The calculated maintenance volume must be adjusted based on specific clinical conditions: 1

Reduce to 65-80% of calculated volume (≈1,200-1,480 mL/day):

• Pneumonia, CNS infection, or postoperative state (high ADH secretion risk) 1
• Mechanical ventilation 1
• Temperature-controlled environments 1

Reduce to 50-60% of calculated volume (≈925-1,110 mL/day):

• Renal failure 1, 2
• Heart failure or hepatic failure 1

Increase above standard calculation:

• Fever, hyperventilation, or hypermetabolism 1, 2
• Ongoing gastrointestinal losses 1

Total Fluid Accounting

The calculated maintenance volume must incorporate ALL fluid sources, not just the primary IV line: 1

• Intravenous maintenance fluids
• Blood products 1
• All IV medications (continuous infusions and boluses) 1
• Arterial and venous line flush solutions 1
• Enteral intake 1

Replacement fluids for acute losses or massive transfusion are NOT included in the maintenance calculation. 1

Critical Safety Considerations

Avoid hypotonic fluids (sodium <130 mEq/L) for routine maintenance, as they are associated with fatal hyponatremic encephalopathy. 1, 2 This is particularly important in the first 24 hours of hospitalization for acutely ill children. 2

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

Monitoring Requirements

Reassess the child at least daily, evaluating: 1

• Overall fluid balance and clinical status
• Serum sodium concentration to detect hyponatremia
• Signs of fluid overload (increased respiratory rate, crackles, hepatomegaly) or dehydration (decreased skin turgor, dry mucous membranes)
• Daily weight measurements and strict input/output recording

Do not continue full maintenance rates without reassessment if the child develops fluid overload, oliguria, or any change in clinical condition. 1