How to calculate pediatric I&O and caloric intake

  1. I've done the math already, formula was given to us and I went by that. I feel like I may have done it wrong or that my patients I&O is excessive? Patient has chronic constipation. Labs are normal except for platelets were elevated at a 443 and creatinine decreased at 0.23

    my patient is 15.422kg, so I rounded it down to 15kg.

    24 hour actual intake: 5218 ml 24 hour actual output: 3200 ml
    24 hour required intake: 1250 ml 24 hour minimum output: 360 ml


    1000ml for first 10kg
    50ml/kg over 10kg
    above is the formula for 11-20kg kids


    50ml x 5kg = 250
    1250ml/24 hour min intake


    1-2ml/kg/hr
    this is the formula for the output for children less than 30kg


    1ml/15kg/hr
    15 x 24hr = 360ml/24 hour


    Is the child meeting the minimum required intake? Yes
    Is the child meeting the minimum required output? Yes
    Is the I/O balanced? (out should be approximately 2/3 of in) I'm not sure how to do this part. I'm assuming divide the intake by 3 and compare that to the output?


    24 hour caloric needs: 1200


    80kcal/kg/24hr
    above is the nutrition requirement for 4-10 y/o children.
    80kcal x 15kg = 1200kcal/24 hour
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  2. 10 Comments

  3. by   meanmaryjean
    A 15 kg (~30#) child who had over a GALLON in intake? Are you sure???
  4. by   xmilkncookiesx
    I'm going by the formula that was given to me. That's why I'm asking for help .....
  5. by   xmilkncookiesx
    Quote from meanmaryjean
    A 15 kg (~30#) child who had over a GALLON in intake? Are you sure???
    the actual intake and output, is what I found on their chart. That's the intake and output they had for a 24 hour period for that patient.
  6. by   meanmaryjean
    Quote from xmilkncookiesx
    the actual intake and output, is what I found on their chart. That's the intake and output they had for a 24 hour period for that patient.
    What type of intake? I'm wondering if it involved PD fluid (peritoneal dialysis) and effluent- because I just don't see a toddler being able to take in that much.

    OR was this a cumulative total for the whole hospital stay? Our system kept that number as a running total as well.
  7. by   xmilkncookiesx
    Quote from meanmaryjean
    What type of intake? I'm wondering if it involved PD fluid (peritoneal dialysis) and effluent- because I just don't see a toddler being able to take in that much.

    OR was this a cumulative total for the whole hospital stay? Our system kept that number as a running total as well.
    Honestly I'm not sure. I didn't even get to meet my patient because they left to OR early in the morning before report began. The patient was in OR all day for biopsy. They did have continuous infusion, so would that be a reason they had that much intake?

    Also, they were made NPO at midnight prior to surgery but still had fluids running I believe.

    Also, the patient had dextrose 5% and 0.9% NaCl with KCL cont. infusion running, according to their chart. It also said they had enteral feedings but I couldn't click to open it. But that was the total I&O for the patient in a 24 hour period
  8. by   meanmaryjean
    That would still be an EXTREMELY large amount of intake. Maybe the OR really blasted them with fluid for whatever reason, but I really can't say.
  9. by   KelRN215
    There's no way 5L can be the correct intake for a 15 kg child. Maintenance fluid for a child of this size would be 50 mL/hr. Even if the child needed fluid boluses, those are usually done as 10-20 mL/kg, so a bolus for this child would be 300 mL max.

    What was this child's diagnosis? This small child is 2 liters positive for 24 hours?
  10. by   xmilkncookiesx
    Quote from KelRN215
    There's no way 5L can be the correct intake for a 15 kg child. Maintenance fluid for a child of this size would be 50 mL/hr. Even if the child needed fluid boluses, those are usually done as 10-20 mL/kg, so a bolus for this child would be 300 mL max.

    What was this child's diagnosis? This small child is 2 liters positive for 24 hours?
    chronic constipation, hirschprung's disease.
  11. by   KelRN215
    Quote from xmilkncookiesx
    chronic constipation, hirschprung's disease.
    Does the child have an ostomy? Is he or she on TPN?

    Also, these are CHRONIC diagnoses. What was the child admitted for?

    I have been a pediatric nurse for almost 10 years and I cannot think of any way that a 15 kg child would have 5L of intake and 3L of output for a day. That means this child is holding onto 2L of extra fluid (4.4 pounds of fluid) for one and 5L of intake is abnormal for even an adult. That was my intake when I was diagnosed with diabetes insipidus at 26!
  12. by   xmilkncookiesx
    Quote from KelRN215
    Does the child have an ostomy? Is he or she on TPN?

    Also, these are CHRONIC diagnoses. What was the child admitted for?

    I have been a pediatric nurse for almost 10 years and I cannot think of any way that a 15 kg child would have 5L of intake and 3L of output for a day. That means this child is holding onto 2L of extra fluid (4.4 pounds of fluid) for one and 5L of intake is abnormal for even an adult. That was my intake when I was diagnosed with diabetes insipidus at 26!
    Her diagnosis said constipation, thats what she was admitted for, and its chronic. She's had a history of it and has hirschprung's disease.

    I stated in my post that I wasn't able to meet her because she left to OR early and was there almost all day for biopsy. Her chart didn't mention anything about having an ostomy. Her I&O showed that she had enteral feedings but when I clicked on it to open it up and see what exactly it was, it wouldn't let me.

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