Pediatric Fluid Maintenance

the hasbro children's hospital pediatric surgery handbook lists the following formulae:

neonatal requirements

day#1: 60ml/kg/day

day#2: 80ml/kg/day

day#3: 100ml/kg/day

thereafter 100-150 ml/kg/day.

fluids in older children

the maintenance fluid requirements of older children are also based on ml/kg/day.

1-10 kg: 100 ml/kg/d

11-20 kg: 1000 ml + 50 ml/kg above 10 kg/d

21-30 kg: 1500 ml + 20 ml/kg above 20 kg/d

> 30 kg: 1700 ml + 10 ml/kg above 30 kg/d

another way to remember this (also known as the 4/2/1 rule):

first 10kg: 100ml/kg/d = 4ml/kg/hr

next 10kg: 2ml/kg/hr in addition to the rate for the first 10kg (40ml/hr)

next 10kg:1ml/kg/hr in addition to the rate for the first 20kg (60ml/hr) (can be used for weights >30 kg)

if you calculate the 24 hour fluid requirement and hourly infusion rate using both methods you will find that they are not the same. this variation should not be significant as this is a calculated starting point only and the actual infusion rate may need to be adjusted based upon clinical findings.

Pediatric calculations are ok until I got stuck on my last question regarding fluid maintenance. Can someone explain it? I have the following problem.

The child weighs 17kg. would need how many ml/day of fluids for maintenance? and how many ml/hr?

I thought it was 1000 ml/24hrs plus 50/kg/day????? I am so stuck it's making my head spin. Please help. Thanks...

We were given the following formula for 100% maintenance in 24 hour fluid requirements in Pediatrics:

Thus your example of 17 Kg would break down to the following:

17 Kg = (10 Kg @ 100 ml/Kg) + (7 Kg @ 50 ml/Kg)

= (10 Kg * 100 ml/Kg) + (7 Kg * 50 ml/Kg)

= (1000 ml) + (350 ml)

= 1,350 ml/24 hrs

or

= 56 ml/hr

hey just wondering if you passed your math test?? I am in the same boat you are.

Thank you for asking... I take my math test next week.... I am practicing math calculations right now.... I had my Peds clinical today.. Yep, I have a Saturday clinical.... :chuckle

eww clinicals on saturday . yea i take my math test on tuesday at noon, stressful!! I have been practicing math all day and making up problems and redoing them. i am dreaming about this d@mn test. lol. I am in ob/peds right now, except i only have 3 weeks untill we are done with school. so failing this test means failing out with only 3 weeks left of school. irregardless to my grades! the first time i rounded gtt/min to the nearest hundredth which in the directions stated for dosage problems and iv to nearest whole number. so instead of rounding to the hundredths i should of rounded to the nearest whole number. i have to get a 90% !!

try this problem one i made up ( actually just changed the numbers on the paper, eheheh)

ordered: kantrex 30mg/kg/day in 4 divided doses.

available: kantrex 200 mg/2ml

wt: 50 pds

give:_______

----------------------answer-----------

i got 1.7ml you??

We were given the following formula for 100% maintenance in 24 hour fluid requirements in Pediatrics:

1st 10 Kg of body weight, give 100 ml/Kg

2nd 10 Kg of body weight, give 50 ml/Kg

Above 20 Kg of body weight, give 20 ml/Kg

Just being curious, as I don't do pediatrics, I do neonates, But..trying to work out your formula out of interest.

If you had for example, a kid who weighed 30 kgs, would you give

150ml/kg, ....Plus another 20ml/kg?

If it weighed 40 kgs, would it be the same???

Or if the kid was 30kgs would it just be 20ml/kg, which doesn't sound a lot of fluid replacement?

In our NICU, we go 60 mls/kg: 90 mls/kg; 120mls/kg; and take it from there. Sometimes we start on 75 mls/kg..eg hypoglycaemia, or can go from 60-75 if conservative management of say cardiac babies.

Usually end up at 180mls /kg on long term preemies who are not yet demand feeding.

4x4 I got the same thing, 22.7kg for the child's weight.

22.7kg x 30mg = 681mg/day

681mg/ 4doses = 170.25

170mg/200 mg x 2ml = 1.7 ml

I think we are going towards an A for our test next week.... BEST OF LUCK!!!!!!

Hi Danissa,

40 Kg?

(10*100)+(10*50)+(20*20) = 1900 ml/24hr = 79 ml/hr

Is this what you mean?

Hi Adpie10, I dont quite know, i was a bit flummoxed by the formula.

Just interested in how to work out that paeds formula, as opposed to neonates, where it seems so simple!

if it were the case that you had a 40kg kid, then yes, would you give 150mls/kg for the first 20kg...(ok, easy!)

but would you then add 20mls/kg over the weight or would you go with just 20mls/kg which seems such a little

Thanks all will need this for 3rd semester starting in august.