Pediatric Maintenance Fluid Rate Calculator
Calculate maintenance requirements using the Holliday-Segar (4-2-1) Method.
Calculated Maintenance Rates
Standard Resuscitation Bolus (20 mL/kg)
— mL
*Consult medical guidelines for specific clinical situations (e.g., cardiac issues).Understanding Pediatric Maintenance Fluids
In pediatric medicine, determining the correct intravenous (IV) fluid rate is critical. Unlike adults, children's metabolic rates and fluid requirements vary significantly based on their weight. The gold standard for calculating these needs is the Holliday-Segar Method, often referred to as the 4-2-1 Rule.
The 4-2-1 Rule (Hourly Maintenance)
The 4-2-1 rule is the most common way to calculate the hourly infusion rate for pediatric patients:
- 0 to 10 kg: 4 mL/kg/hr
- 11 to 20 kg: 40 mL/hr + 2 mL/kg for every kg over 10
- Over 20 kg: 60 mL/hr + 1 mL/kg for every kg over 20 (up to a max, typically 100-120 mL/hr)
The 100/50/20 Rule (Daily Maintenance)
This method calculates the total fluid requirement over a 24-hour period:
- First 10 kg: 100 mL/kg/day
- Next 10 kg: 50 mL/kg/day
- Remaining weight: 20 mL/kg/day
Example Calculation (25kg child):
- First 10kg = 40 mL/hr
- Next 10kg = 20 mL/hr
- Remaining 5kg = 5 mL/hr
- Total = 65 mL/hr
Clinical Considerations
While this calculator provides maintenance rates, clinicians must adjust these numbers based on the patient's specific condition:
- Dehydration: May require additional replacement fluids.
- Inappropriate ADH Secretion (SIADH): May require fluid restriction.
- Renal or Cardiac Failure: Often requires significant fluid restriction.
- Electrolytes: Standard maintenance typically uses D5 1/2NS + 20 mEq/L KCl, but isotonic fluids (like 0.9% NS) are now often preferred to prevent hyponatremia.
Disclaimer: This calculator is for educational purposes only. Medical decisions should be made by licensed healthcare professionals based on complete clinical assessments.