Holliday-Segar 4-2-1 maintenance fluid
Daily and hourly fluid maintenance using the 4-2-1 rule: 100 ml/kg for first 10 kg, 50 ml/kg for next 10, 20 ml/kg beyond.
About this calculator
The Holliday-Segar 4-2-1 method calculates daily pediatric maintenance fluid requirements. Proposed by Holliday and Segar (Pediatrics, 1957) based on metabolic needs. Remains the pediatric IV fluid standard. Formula. First 10 kg – 100 mL/kg/day. Next 10 kg (11-20 kg) – 50 mL/kg/day. Each additional kg (>20 kg) – 20 mL/kg/day. Hourly: 4 mL/kg/hour for first 10 kg, 2 mL/kg/hour for next 10 kg, 1 mL/kg/hour per kg above 20 (the 4-2-1 rule). Examples. 8 kg child – 800 mL/day (~33 mL/hour). 25 kg child – 1000 + 500 + 100 = 1600 mL/day (~67 mL/hour). 60 kg adolescent – 1000 + 500 + 800 = 2300 mL/day (~96 mL/hour). Clinical use. NICE 2015 recommends Holliday-Segar for maintenance IV in all children over 28 days. Fluid choice – isotonic (0.9% saline or Plasmalyte-A) with 5% dextrose. Hypotonic fluids (0.45% saline) are prohibited by NICE and FDA after pediatric hyponatremic encephalopathy cases. Limitations. Not used in dehydration – needs separate rehydration calculation (rapid 20 mL/kg isotonic bolus, repeated as needed). Does not capture elevated losses with fever (+12% per degree above 37.5), burns, diarrhea, vomiting, drains, tachypnea. Not validated in preterm – they use age-in-days calculations. In adults the formula is inaccurate – use 30-35 mL/kg/day or 1500 mL/m²/day by body surface area.
Source
Formula version: holliday-segar-1957-v1
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