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The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Accounting for deficits when determining the fluid. Maintenance fluid therapy as defined by Holliday and The formula assumes normal renal function . Holliday/Segar formula of ml/kg body weight (BW). The Maintenance Fluid Calculation for Children helps to determine the daily volume of fluids needed based on the weight of a child. This calculation also.

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Caloric expenditure, and therefore the water requirement, for the hospitalized patient can be estimated from the nomogram shown below. Later, seizures were misperceived as fidgeting from pain.


A jolliday for using isotonic saline. Rehydration is divided into segqr phases. Any renal dysfunction requires frequent electrolyte monitoring. The subsequent symptoms of hyponatremia were mistaken for a dystonic reaction from promethazine, and the child was treated with diphenhydramine.

When determining the amount of fluid to be administered in phases II and III, the fluid volume given during phase I should be subtracted from the deficit fluid.

That is, for every kilocalories burned, the patient utilizes ml.

Index of Core Concept Chapters. Some more words of caution: Maintenance electrolyte requirements must be taken into account, with particular attention paid to sodium requirements, as recent evidence suggests that sodium needs in hospitalized children are higher than originally thought.

The potential for hyponatremia or hypernatremia emphasizes the need for close monitoring of serum sodium in hospitalized children receiving intravenous fluid therapy, particularly in the post-operative period. Replacement fluids differ from seyar fluids in that they are ongoing, as opposed to a loss of fluid that occurred prior to receiving medical treatment.

Treatment of burns in children. Fluid therapy is divided into maintenance, deficit, and replacement requirements. Calculate the maintenance water required for 30 kg child?


For example, if a parenteral antibiotic is being mixed in mL and given four times per day, this could provide a significant amount of fluid to the patient. Footnotes Data from Rusconi F, et al. Maintenance fluid can be defined as the amount of fluid required to compensate for ongoing fluid losses, thus maintaining steady state in the body. Another monitoring parameter which the pharmacist can impact is the amount of fluid used in the patient’s medications.


Author information Copyright and License information Disclaimer. Ensuring that the patient is not getting an excessive amount of fluids in medications can help prevent overhydration. By continuing to use this website, you agree to their use. Generally these equations involve more calculations, and the basal calorie requirement method requires an indirect calorimeter, which is an expensive piece of equipment. Generally speaking, phases II and III are simply maintenance fluid plus deficit fluid, given over 24 hours, with half of the deficit fluid given in the first 8 hours, and the second half of the deficit fluid given in the last 16 hours Table 6.

By the time a patient is out of the neonatal period, the usual dose of gentamicin is 2. Young TE, Mangum B, editors. By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child.

Determining an initial fluid rate for children based upon their needs is essential. In phase I, a bolus of fluid is given in order to restore blood volume to ensure adequate perfusion of critical organs, such as the brain.

Notify me of new comments via email. Sodium polystyrene sulfonate is an exchange resin which exchanges sodium for potassium in the gut; 19 its use is generally for less emergent situations.

Other clinical signs include increased thirst, dry mucous membranes, and decreased urine output Table 3. This site uses cookies. Other methods of estimating maintenance fluid requirements exist, including those using body surface area and basal calorie requirements.

Pediatric Fluid and Electrolyte Therapy

Hospitalized children frequently have elevated fluid requirements due to their illness. This formula relates water loss to the caloric expenditure. Replacement Fluids Replacement fluids are defined as those given to meet ongoing losses due to medical treatment.


This formula relates water loss to the caloric expenditure.

Fluid and Electrolyte Therapy

Applying the principles of pharmacokinetics to a working formu,a of fluid and electrolytes in children hoolliday help pharmacists individualize medication therapy to the specific needs of the patient. Weldone,bro david Like Like. Once the degree of dehydration is established, the type of dehydration, defined by serum sodium concentrations, needs to be determined.

Recently, two pediatric deaths from hyponatremia have been reported in post-operative situations. On the sebar post-operative day, the patient was unarousable, and this was confused for a side effect of receiving hydromorphone. Holliday Fluid Requirements T he commonly used method for approximating water loss and therefore the water requirement is the Holliday-Segar nomogram: Jospe N, Forbes G.

Pharmacists should always pay particular attention segaf the hydration status of patients, as the volume of distribution for water soluble drugs can be drastically affected by a change in volume status.

Monitoring serum electrolytes is necessary if the patient has electrolyte abnormalities, but when examining hydration, the most important indices to watch are the clinical parameters mentioned earlier. Calculate the daily maintenance fluid of the child. As mentioned previously, the large percentage of total body water in neonates has a great impact on therapy with water-soluble drugs, such as aminoglycosides. Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy.

Organizing fluid therapy into maintenance, deficit, and replacement requirements, and then monitoring the patient for response to therapy makes fluid therapy manageable. The method is based on the weight of patient in kilogram.