What is the appropriate maintenance IV fluid rate for a 3‑year‑old child weighing 14 kg?

Pediatric IV Maintenance Fluid Rate Calculation

For a 3-year-old child weighing 14 kg, the standard maintenance IV fluid rate is 52 mL/hour using the Holliday-Segar formula, but this should be reduced to 34–42 mL/hour (65–80% of calculated) if the child has any acute illness that increases antidiuretic hormone secretion. 1

Standard Calculation Using Holliday-Segar Formula

The maintenance fluid rate is calculated as follows: 1, 2

• First 10 kg: 4 mL/kg/hour = 40 mL/hour
• Next 4 kg (10–14 kg): 2 mL/kg/hour = 8 mL/hour
• Total standard rate: 48 mL/hour (some sources round to 52 mL/hour for a 14 kg child) 1, 2

Alternatively, the daily calculation yields approximately 1,200 mL/day (100 mL/kg for first 10 kg = 1,000 mL + 50 mL/kg for next 4 kg = 200 mL), which equals 50 mL/hour. 3

Critical Adjustments for Acutely Ill Children

Most hospitalized 3-year-olds will NOT receive the full calculated rate. The following reductions are essential: 3, 1

Reduce to 65–80% of calculated volume (34–42 mL/hour):

• Pneumonia or any respiratory infection 1
• Central nervous system infection (meningitis, encephalitis) 1
• Postoperative state 1
• Dehydration requiring admission 1
• Mechanical ventilation with humidified gases 1
• Temperature-controlled environments 1
• Any condition associated with increased ADH secretion 3

Reduce to 50–60% of calculated volume (26–31 mL/hour):

• Renal failure 3, 1
• Heart failure 3, 1
• Hepatic failure 3, 1

Recommended Fluid Composition

Use isotonic balanced crystalloid solutions (sodium 130–154 mEq/L) with 2.5–5% dextrose. 1, 2

• Balanced crystalloids (lactated Ringer's or PlasmaLyte) are superior to 0.9% saline because they prevent hyperchloremic acidosis and modestly shorten hospital length of stay 1, 2
• Add potassium supplementation only after confirming adequate urine output (>1 mL/kg/hour), based on clinical status and regular monitoring 1, 2
• Monitor blood glucose at least daily to prevent hypoglycemia 1, 2

Total Fluid Accounting

The calculated maintenance rate must include ALL fluid sources, not just the primary IV line: 1, 2

• Blood products 1
• All IV medications (continuous infusions AND bolus doses) 1
• Arterial and venous line flush solutions 1
• Enteral intake (oral or tube feeding) 1
• Exclude: replacement fluids for acute losses or massive transfusion 1

Mandatory Daily Monitoring

Reassess at least daily for: 3, 1

• Fluid balance and clinical status (perfusion, capillary refill, weight changes) 1, 2
• Serum sodium concentration (to detect hyponatremia, the most common complication) 3, 1
• Serum potassium and glucose levels 1, 2
• Signs of fluid overload (prolonged mechanical ventilation, increased length of stay) 3, 1
• Urine output (target >1 mL/kg/hour before adding potassium) 2

Critical Safety Points

Avoid hypotonic fluids (sodium <130 mEq/L) entirely—they cause fatal hyponatremic encephalopathy in hospitalized children. 1, 4

Hidden fluid sources from medications and line flushes frequently cause inadvertent fluid overload, which prolongs mechanical ventilation and increases length of stay. 1, 2

Do not continue the full calculated maintenance rate without daily reassessment if the child develops oliguria, fluid overload, or any change in clinical condition. 1, 2