The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Accounting for deficits when determining the fluid. Maintenance fluid therapy as defined by Holliday and The formula assumes normal renal function . Holliday/Segar formula of ml/kg body weight (BW). The Maintenance Fluid Calculation for Children helps to determine the daily volume of fluids needed based on the weight of a child. This calculation also.

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It helps to estimate the fluid requirement in 24 hours. Respiratory Rates in Children.

Maintenance electrolyte requirements must be taken into account, with particular attention paid to sodium requirements, as recent evidence suggests that sodium needs in hospitalized children are higher than originally thought. Patients with hypotonic or isotonic dehydration are given fluids using the same technique to calculate fluid amount and rate Table 5. Esgar Center Support Center. This is generally given over a few hours, with serum sodium checks done throughout in order to avoid hypernatremia.

Hydration status can have an important impact on drug therapy, and should be considered when using medications with formulw volumes of distribution.

Hospitalized children frequently have elevated fluid requirements due to their illness. Body water compartments in children: The hour number is often divided into approximate hourly rates for convenience, leading to the “” formula.

Maintenance fluids are given to compensate for ongoing losses and are required for all patients. However, if the infant presents in a dehydrated state, and therefore has a smaller volume of distribution, giving a standard dose for the patient’s age may result in a toxic serum concentration.


The subsequent symptoms of hyponatremia were mistaken for a dystonic reaction from promethazine, and the child was treated with diphenhydramine. Each of these examples demonstrates a situation where there is an ongoing loss which would not be met by administering only maintenance fluids. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy.

Recently, two pediatric deaths from hyponatremia have been reported in post-operative situations. Caloric expenditure, and therefore the water requirement, for the hospitalized patient can be estimated from the nomogram shown below. The degree of dehydration calculated should always be compared to the clinical signs, which may be better indicators of hydration status and are also especially useful when a pre-illness weight is unknown.

By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child. Replacement fluids are defined as those given to meet ongoing losses due to medical treatment.

N Engl J Med. Replacement Fluids Replacement fluids are defined as those given to meet ongoing losses due to medical treatment. Fill in your details below or click an icon to log in: The increased volume of distribution necessitates a large dose.

Fluid and Electrolyte Therapy

Prevention of hospital-acquired hyponatremia: By continuing to use this website, you agree to their use. The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Calculate the maintenance fluid to be given to a patient weighing 22kg. Young TE, Mangum B, editors. Phase III is given over 16 hours. Determining an initial fluid rate for children based upon their needs is essential.


Clinical signs of dehydration should be taken into consideration first, as they can provide useful insight into the fluid needs of the hollifay. Examples of clinical situations where replacement fluids are needed include patients with chest tubes in place, uncontrolled vomiting, continuing diarrhea, or externalized cerebrospinal fluid shunts.


These hplliday include insulin and beta adrenergic agonists such as albuterol. Fluid therapy is divided into maintenance, deficit, and replacement requirements. The first parameter for monitoring is oral intake Table 6. You are commenting using your Twitter account. Holliday Segar determined how many calories a patient burns as a factor of weight.

For this reason, when calculating maintenance fluids, pharmacists must always keep in mind factors that may affect fluid balance and changed needs.

Monitoring patients’ weights can be especially important, particularly in infants, as younger patients tend to present with more significant weight loss when dehydrated. Holliday segar method is a widely acceptable method of calculating maintenance fluid, especially in children. In phase I, a bolus of fluid is given in order to restore blood volume to ensure adequate perfusion of critical organs, such as the brain. Wegar C, Del Rio M. In addition to total body water differences, the percent of body weight accounted for by intracellular and extracellular water also changes.