Skip to content

IV FLUID PRESCRIBING

SHARE VIA:

Maintenance fluids

Maintenance fluids are prescribed using the Holliday-Segar formula:

Option 1 – 4:2:1 rule for the hourly requirement

4 ml/kg/hr for the first 10 kg, then 2 ml/kg/hr for the second 10 kg, then 1 ml/kg/hr for each subsequent kg

For example a 22kg child – (4 x 10) + (2 x 10) + (1 x 2) = 62 ml/hr

Option 2 – 100:50:20 rule for the daily requirement

100 ml/kg/hr for the first 10 kg, then 50 ml/kg/hr for the second 10kg, then 20 ml/kg/hr for each subsequent kg

For example a 22kg child – (100 x 10) + (50 x 10) + (20 x 2) = 1540 ml/day = 64ml/h

Rehydration fluids

Assessment of dehydration

The Clinical Dehydration Scale utilises four key examination findings:

• presence or absence of tears
• mucous membranes
• whether the eyes are sunken or not
• the general appearance of the child.

Combined items give this scale a sensitivity of around 68%.

Fluids to treat dehydration:

% dehydration x weight x 10g

For example a 22kg child who is 5% dehydrated: 5 x 22 x 10 = 1100 ml

Then calculate the hourly rate. Replace over either 24 hours (if the child became dehydrated very rapidly) or over 48 hours (most children).

For the 22kg child who is 5% dehydrated: 1100 ÷ 48 = 22.9 ml/hr

Add the dehydration fluids to the hourly maintenance fluids

For the 22kg child: 62 ml/h + 22.9 ml/h = 84.9 ml/h

 

*The reason dehydration fluids are multiplied by a factor of 10 is to do with percentages and converting litres to millilitres. Percentages are divided by 100. We need to convert weight from kilograms to grams (to do the equivalent litres to millilitres) by multiplying by 1000. Rather than dividing the percentage by 100 and multiplying the whole amount by 1000, we just multiply up by a factor of 10 (1000 ÷ 100 = 10).

Characteristic012
General appearanceNormalThirsty, restless, or lethargic, but irritable when touchedDrowsy, limp, cold, sweaty, and/or comatose
EyesNormalSlightly sunkenVery sunken
Mucous membranesMoist'Sticky'Dry
TearsTearsDecreased tearsAbsent tears
Scoring: 0: no dehydration < 3%, 1-4: some dehydration ≤ 3 x < 6%, 5-8: moderate dehydration ≥ 6%

Author

KEEP READING

PECARN C-spine HEADER (2)

Cervical Spine Imaging in Kids – the PECARN rule

, , ,
HIDDEN C HEADER

The ‘Hidden C’

NEC HEADER

Necrotising Enterocolitis

Copy of Trial (1)

Bubble Wrap PLUS – June 2024

Copy of Trial (1)

The 81st Bubble Wrap

PPHNHEADER

Persistent Pulmonary Hypertension of the Newborn

Diagnosing ASPGN HEADER

Diagnosing acute post-streptococcal glomerulonephritis

,
Not a fever HEADER

When is a fever not ‘just a fever’?

Copy of Trial (1)

Bubble Wrap PLUS – May 2024

Copy of Trial (1)

The 80th Bubble wrap x DFTB MSc in PEM

SVT HEADER

SVT in infants

DACRYOCYSTITIS

Dacryocystitis 

PARDS HEADER

Paediatric acute respiratory distress syndrome (PARDS)

, ,
OXY-PICU HEADER

The Oxy-PICU trial

, , ,
Copy of Trial (1)

Bubble Wrap PLUS – April ’24

DFTB WORLD

EXPLORE BY TOPIC