Maintenance Fluid Calculator | Holliday Segar Formula
Maintenance Fluid Calculator determine maintenance IV fluid rates uses the Holliday Segar formula and the 4-2-1 rule. The “4-2-1 rule” is most widely used for adults and pediatric maintenance fluid calculations.
The maintenance fluid calculator uses the Holliday Segar method and the 4-2-1 rule to determine the daily and hourly need for fluids in both adults and pediatric patients. In addition to determining the appropriate pediatric maintenance fluids, you can also calculate the correct size of the pediatric fluid bolus to administer in emergencies.
Other maintenance fluid calculators have been derived and employed, however the “4-2-1” rule remains the most widely used for adults and pediatric populations secondary to its ease of calculation
How to use maintenance fluid calculator?
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Determine whether to use the maintenance fluids calculator, keeping in mind its limitations. Do not use it for newborns under 14 days old, as it overestimates fluid requirements. Additionally, the formula is not suitable for children weighing less than 3 kilograms. The calculator will provide warnings for these cases.
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Input the child’s weight in kgs (for weigth in pounds select lbs)
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You will get two results. The first is daily maintenance fluids — the fluid needed for the whole day — to be given within 24 hours (mL/24hr).
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In the second line, you’ll see the Fluids flow rate (mL/hr). It tells you how fast the intravenous infusion should be.
Keep reading if you would like to find out:
- What is maintenance fluid?
- What is the Holliday Segar Formula, and how can you use it to calculate Maintenance Fluid?
- Holliday Segar Formula and 4-2-1 Rule.
- How to calculate maintenance fluid using holliday segar formula and 4-2-1 rule?
- Maintenance fluid calculation examples and more.
One of the primary objectives of maintenance IV fluid therapy is to provide water to meet physiologic losses (insensible loss + urine loss). In a study published in 1957, in the Journal Pediatrics, Malcolm Holliday and William Segar developed a simple scheme which could be easily remembered to calculate the maintenance water needs in hospitalized patients.
Maintenance fluid
Maintenance fluid can be defined as the amount of fluid required to compensate for ongoing fluid losses, thus maintaining steady state in the body. It can be given by intravenous routes or oral routes (if patient can tolerate orally) or both.
SENSIBLE LOSS & INSENSIBLE LOSS:
The body classifies water losses into two types: SENSIBLE LOSS (which includes urine and faecal water) and INSENSIBLE LOSS (which includes perspiration and respiration).
Holliday Segar Method
Holliday Segar Method is a widely acceptable method of calculating maintenance fluid, especially in children. It helps to estimate the fluid requirement in 24 hours. The method is based on the weight of patient in kilogram. This formula relates water loss to the caloric expenditure that is, for every 100 kilocalories burned, the patient utilizes 100ml (in other words, under normal resting conditions, 1 ml of water is required to metabolize 1 kcal).
The commonly used method for approximating water loss (and therefore the water requirement) is based off of the Holliday-Segar Method.
Holliday Segar Formula
The Holliday-Segar Formula approximates daily fluid loss, and therefore the daily fluid requirements, as follows:
Maintenance Fluid Rate is calculated based on weight (mL/day).
- 100 ml/kg/day for 1st 10kg of body weight
- 50 ml/kg/day for 2nd 10 kg of body weight (11kg – 20kg)
- 20 ml/kg/day for any kilogram of body weight above 20kg (> 20kg)
Holliday Segar 4 -2-1 Rule
The delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate (mL/hr). To determine the hourly rate of fluid maintenance required for a child based on their body weight this Holliday Segar formula has been further simplified, with the hourly requirement referred to as the “4-2-1 rule”
Maintenance Fluid Rate is calculated based on weight (mL/hr).
- 4 ml/kg/hr for 1st 10kg of body weight
- 2 ml/kg/hr for 2nd 10 kgof body weight(11kg – 20kg)
- 1 ml/kg/hr for any kilogram of body weightabove 20kg (> 20kg)
Maintenance fluid Calculations Example
In the end of these maintenace fluid calculations examples you will know how to calculate pediatric maintenance fluid requirements using both Holliday Segar formula and 4 2 1 rule.
What will be the maintenance fluid requirement for a child weighing 6kg? Using both Holliday Segar Formula and 4-2-1 Rule.
For full maintenance fluid — Holliday-Segar method
Weight= 6kg (this falls within first 10kg)
Formula: 100 ml/kg/day for 1st 10kg of body weight
Thus, = 100ml × 6 = 600ml
Therefore, the child requires 600ml of fluid in 24hrs (per day).
To express it in ml per hour, divide 600ml by 24hrs = 25 mL/hr
For hourly maintenance rate – 4-2-1 Rule
Using 4, 2, 1 formula (Holliday – Segar’s Formula) More accurate for ml/hr calculation.
Weight= 6kg (this falls within first 10kg)
Formula: 4 ml/kg/hr for 1st 10kg of body weight
Thus, = 4ml × 6 = 24ml/hr
Therefore, the child requires 24ml of fluid in per hour.
General Tips
- Check that your answer makes sense clinically.
- Triple check your work.
- Have a colleague or pharmacist check your work.
- Know general therapeutic drug doses for commonly administered medications.
- Advice: Past, current, and future hydration status should always be considered when prescribing maintenance fluids, as under-dosing will lead to dehydration and renal insufficiency, and over-dosing may lead to fluid overload and edema in some patients.
- Notes: The Holiday-Segar method can only apply to patients above 2 weeks of age. Additionally, the formula is not suitable for children under 3 kilograms.
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