Maintenance Fluids Calculator
Calculate pediatric IV maintenance fluids using Holliday-Segar daily rates, 4-2-1 hourly rule, and isotonic bolus volume.
What Are Pediatric Maintenance Fluids?
Maintenance intravenous fluids replace ongoing sensible and insensible water losses in children who cannot take adequate oral intake. The Holliday-Segar method estimates total daily fluid needs from body weight, while the 4-2-1 rule gives an equivalent hourly infusion rate. These formulas apply to euvolemic children needing baseline hydration, not resuscitation of shock or replacement of large ongoing losses.
Holliday-Segar Daily Calculation
Daily maintenance volume equals 100 mL per kg for the first 10 kg, plus 50 mL per kg for the next 10 kg, plus 20 mL per kg for each kilogram above 20 kg, over 24 hours. For a 14 kg child: (10 × 100) + (4 × 50) = 1,200 mL per day. Fluid type (isotonic vs hypotonic) depends on age, sodium status, and clinical setting per institutional protocols.
4-2-1 Hourly Rule and Bolus Volume
The 4-2-1 rule delivers 4 mL/h per kg for the first 10 kg, 2 mL/h per kg for the next 10 kg, and 1 mL/h per kg above 20 kg. A 14 kg child receives 48 mL/h, matching 1,200 mL over 24 hours. For acute dehydration, an isotonic bolus of 20 mL per kg (capped at 1,000 mL) is often used before switching to maintenance rates once hemodynamically stable.
Frequently Asked Questions
What is the Holliday-Segar formula?
Maintenance fluids per 24 hours: 100 mL/kg for the first 10 kg, 50 mL/kg for kg 11 to 20, and 20 mL/kg for each kg above 20. This estimates daily water requirements in euvolemic children.
How does the 4-2-1 rule work?
Hourly rate: 4 mL/h per kg for the first 10 kg, 2 mL/h per kg for the next 10 kg, and 1 mL/h per kg for weight above 20 kg. It produces the same total volume as Holliday-Segar over 24 hours.
How much bolus fluid should a child receive?
A common isotonic bolus is 20 mL per kg, with a maximum of 1,000 mL per bolus. Repeat boluses based on perfusion, heart rate, and urine output per pediatric resuscitation guidelines.
Can these formulas be used in newborns?
Holliday-Segar and 4-2-1 are designed for infants and children, not neonates under 14 days. Newborns have higher insensible losses and require weight-specific neonatal fluid protocols. Very low birth weight infants need specialized calculations.
When should maintenance rates be adjusted?
Increase fluids for fever, tachypnea, diarrhea, or high urine output. Decrease or restrict fluids in heart failure, renal impairment, or syndrome of inappropriate antidiuretic hormone. Always reassess clinical status and electrolytes during IV therapy.
Related Tools
Hazen Williams Calculator
Fibonacci-like Series Generator
CPA Calculator
Convert Bytes To Ascii
Butter Calculator
Enigma Machine Simulator
Fake Instagram Post Generator
Random Wheel
Thanksgiving Calories Calculator
Uniform Distribution Calculator
Generator Wattage Calculator
Force Converter
Text to Handwriting Converter
Ounce to Kg Converter
Cat Chocolate Toxicity
Consumer Surplus Calculator
Hat Size Calculator
ABI Calculator
Sims 3 Trait Generator
Caffeine Calculator