IV Fluid Replacement Question Debating Book Answer

A client is receiving IV fluid replacement. The order states to give 1000 ml for the first 10 kg and 50ml/kg each 10-20 in 24 hours. The client weights 19.5 kg, what should the nurse set the hourly rate at?

This question was on a comprehensive test our instructor gave us in prep for the NCLEX. I had a problem with the wording and understanding of the question, I get the mathematical part of it.

My question is after the first 1000 ml is given my instructor said that the leftover 9.5 kg (19.5-10= 9.5) should be multiplied by 50 ml and that is added to the first 1000 and divided by 24 to get the hourly replacement. My thing is the 10-20 part doesn't make sense to me. 9.5 kg doesn't fit in the range of 10-20 kg so why would we multiply it by 50 then add that to the 1000 ml part? It would make sense if the range was 9-20 kg I would've added it but if its 9.5 its not in the range of the order and wouldn't be used to add the additional fluid. Anyone else with me on this? I debated with her for a few minutes and she just kept showing me how to do it but wasn't explaining why. I get how she got the answer and how to work the problem.

Help?!

2 Answers

To determine daily pediatric maintenance IV fluid requirements you can use the following formula:

1 - 10 kg: 100 ml/kg/day

11 - 20 kg: 1000 mL + 50 mL per each kg >10kg

21 - 30kg: 1500 mL + 20 mL per each kg >20 kg.

>30 kg: 1700 mL + 10 mL per each kg >30.

Using this formula, the daily IV fluid requirement for a 19.5 kg patient is 1475 mL (1000 mL for the 1st 10 kg, then 50 mL per kg for 9.5 kg). Dividing by 24 hours, the hourly infusion rate would be 61.5 mL/hour (62 mL/hour).

Alternatively, to calculate the hourly pediatric maintenance IV fluid requirement:

1 - 10 kg: 4 mL/kg/hour.

11 - 20 kg: 40 mL/hour + 2 mL/hour per each kg >10.

>20 kg: 60 mL/hour + 1 mL/hour per each kg >20.

THIS MAKES SENSE!!! Thank you. the answer you gave is the same as the book answer. The way you broke it down made the lightbulb go on! knew i just wasn't understanding the question i could do the math part. THank you so much. i feel silly but so glad you replied. thanks a million!!

+ Join the Discussion