Question 1

What is the Holliday-Segar formula for maintenance fluids?

Accepted Answer

The Holliday-Segar formula (also called the 4-2-1 rule) calculates maintenance IV fluid rates based on body weight: 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for each kg above 20. For a 25 kg child: (10 x 4) + (10 x 2) + (5 x 1) = 65 mL/hr or 1,560 mL/day.

Question 2

How does the 4-2-1 rule work for a 15 kg child?

Accepted Answer

For 15 kg: first 10 kg at 4 mL/kg/hr = 40 mL/hr, next 5 kg at 2 mL/kg/hr = 10 mL/hr. Total = 50 mL/hr or 1,200 mL/day. The daily equivalent uses the 100-50-20 rule: (10 x 100) + (5 x 50) = 1,250 mL/day (slight rounding difference from hourly calculation).

Question 3

What fluid type is used for pediatric maintenance?

Accepted Answer

The most common maintenance fluid is D5 0.45% NaCl (dextrose 5% in half-normal saline) with 20 mEq/L of potassium chloride added. Some protocols use D5 0.9% NS (normal saline) for post-operative patients. Neonates typically receive D10 with lower sodium concentrations. Always follow your institution's protocol.

Question 4

When should maintenance fluids be adjusted?

Accepted Answer

Increase by 10-12% per degree Celsius of fever above 37C. Post-operative patients may need 1.5x maintenance. Restrict to 2/3 maintenance for cardiac failure, renal insufficiency, or SIADH. Burns over 15-20% TBSA require the Parkland formula instead of standard maintenance calculations.

Question 5

Does the Holliday-Segar formula work for adults?

Accepted Answer

Yes. The 4-2-1 rule applies to any weight. A 70 kg adult: (10 x 4) + (10 x 2) + (50 x 1) = 110 mL/hr or 2,640 mL/day. Daily maintenance is often capped at 2,400-2,500 mL/day for patients over 70-80 kg to prevent fluid overload.

Question 6

Does this calculator include fluid replacement for dehydration?

Accepted Answer

No. This calculates maintenance (baseline) fluid needs only. Dehydrated patients need additional replacement fluids calculated separately based on the degree of dehydration (mild 5%, moderate 10%, severe 15% of body weight). Ongoing losses from vomiting, diarrhea, or surgical drains must also be replaced on top of maintenance.

Weight (kg)	mL/hr	mL/day	Calculation
5 kg	20	500	5 x 4 = 20
8 kg	32	800	8 x 4 = 32
10 kg	40	1,000	10 x 4 = 40
12 kg	44	1,100	40 + (2 x 2) = 44
15 kg	50	1,250	40 + (5 x 2) = 50
20 kg	60	1,500	40 + (10 x 2) = 60
25 kg	65	1,560	40 + 20 + (5 x 1) = 65
30 kg	70	1,700	40 + 20 + (10 x 1) = 70
40 kg	80	1,900	40 + 20 + (20 x 1) = 80
50 kg	90	2,100	40 + 20 + (30 x 1) = 90
60 kg	100	2,400	40 + 20 + (40 x 1) = 100
70 kg	110	2,500 (capped)	40 + 20 + (50 x 1) = 110

Calculadora de Fluidos de Manutencao Pediatrica

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Resultado

Formula

Exemplo Resolvido

Calculadora de Fluidos de Manutencao Pediatrica - Regra 4-2-1

Holliday-Segar Quick Reference: Maintenance Fluid Rates by Weight

Perguntas Frequentes

O que e a formula Holliday-Segar?

Como funciona a regra 4-2-1 para uma crianca de 15 kg?

Qual fluido e usado para manutencao pediatrica?

Quando os fluidos de manutencao devem ser ajustados?

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