In a study published in 1957, in the Journal Pediatrics, Malcolm Holliday and William Segar developed a simple scheme which could be easily remembered to calculate the maintenance water needs in . This is based on theoretical . 1,2 Total body water (TBW) is high in the fetus and preterm infant. Fluid resuscitation should be with isotonic fluid. Typical daily needs of an ADULT A "standard" 70 kg patient, who is NBM, euvolaemic, not septic, has normal cardiac and renal function, and no additional ongoing Formulas Used: For 0 - 10 kg = weight (kg) x 100 mL/kg/day. If patients need IV fluids for routine maintenance alone, restrict the initial prescription to: 25-30 ml/kg/day of water and approximately 1 mmol/kg/day of potassium[1], sodium and chloride and approximately 50-100 g/day of glucose to limit starvation ketosis. It was derived based on estimated energy expenditure amongst sicker children admitted to hospitals. PN part of maintenance fluids PN total volume = (Total 24hr fluids - fluids from drips - intravenous fat emulsions - feeds) 24 hour maintenance fluid calculations general . Normal maintenance. Water without sodium goes to the TBW (both in and out of cells). Fluid needs are often calculated on a per body weight basis, with an adult baseline of 30-35mL/Kg.3 This recommendation is adjusted up or down based on specific medical conditions, such as heart failure, liver or kidney disease, as well as if a patient is taking certain medications. This needs to be given as D5 0.33% saline. This dextrose content is insufficient for complete nutritional support but may provide adequate calories to prevent hypoglycemia, depending on the rate of infusion. Setting: Single-center tertiary institution. During early fetal life, TBW represents 90% of total body weight, with 65% being in the extracellular fluid (ECF) compartment. Our focus for this week is MAINTENANCE REQUIREMENTS. Sensible fluid losses refer to typical routes of excretion such as urination and defecation. D5 1/4 NS with 20 mEqKCL/L Use 1/4 NS b/c of kids decreased ability to concentrate urine. My adult nonacutely ill patient, weighing 70 kg with a glomerular fi ltration rate (GFR) greater than 60 mL/min/1.73 m2, is admitted to the general medi- . The timing of one-half isotonic saline therapy may also be influenced by potassium balance. For children >20 kg the daily fluid requirement is 1500 mL + 20 mL/kg for every kg over 20, up to a maximum of 2400 mL daily. The type of fluid replacement depends on the type of fluid lost i.e. Maintenance Fluid Replacement Calculations to determine daily volume needed in children and adults Administer 100mL/kg for the first 10kg of weight, then 50mL/kg for the next 10-20kg, plus 20mL/kg for every kilogram greater than 20kg OR Administer 20-40ml/kg/day (adults only) Determines the pediatric fluid requirement based on the Holliday-Segar Nomogram and the 4-2-1 rule. A child who weighs 12kg is 5% dehydrated. d. Fluid rate in this case should be 2000 mL/m2 to control the drop in osmolarity 2. It is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. 110 mL/hr for a 70 kg pt N.b. 4 mL / kg / hour for the first 10kg of body mass. It is also important to add that since the 2015 intravenous fluid education week and staff survey, the rate at which the gold standard maintenance fluid (as per NICE guidelines) 4% dextrose/0.18% sodium chloride is prescribed within the hospital has increased exponentially. Maintenance Fluid Rate is calculated based on weight. Simply multiply the maintenance fluid requirements (cc/hr) times the amount of time since the patient took PO intake. Maintenance = 1000mL (100 mL/kg for first 10 kg) + 100mL (50 mL/kg for last 2kg) = 1100 mL. Neonates have higher total body water volume than adults, and require a higher main-tenance fluid volume. The 24-hour number is often divided into approximate hourly rates for convenience, leading to the "4-2-1" formula. 23/9/2015 Maintenance and replacement fluid therapy in adults Official reprint from UpToDate www.uptodate.com 2015 UpToDate Maintenance and replacement fluid therapy in adults Author Section Editor Deputy Editor Richard H Sterns, MD Michael Emmett, MD John P Forman, MD, MSc All topics are updated as new evidence becomes available and our peer review process is complete. Step 1: Calculate Preoperative Fluid Losses. Fluid rate = 1,620 / 24 = 68 mL (67.5). If dehydration, remove dextrose from IV fluid, run NS at 1X maintenance General Guidelines for Meals Under 3 yrs of age - up to 30 gms 3-5 yrs of age - up to 30-45 gms 6-10 yrs of age - up to 60 gms 11-14 yrs of age - up to 75 gms Older than 15 yrs of age - up to 90 gms How do you calculate maintenance fluids? IV fluid in children has been based on an article from 1957 that recommends weight-based fluid and glucose for maintenance ( Pediatrics . The goal of maintenance fluid therapy is to preserve water and electrolyte balance and to provide nutrition. Maintenance fluid therapy is indicated for patients that are not eating or drinking, but do not have volume depletion, hypotension, or ongoing losses. Maintenance IV fluids for our nonacutely ill adult patient could be: NICE guideline 5: D5W in 0.2% NaCl with 20 mEq KCl, to run at 75 mL/hour. IV. IV Maintenance Fluids Calculator. Replacement fluids (e.g., LRS) are intended to replace lost body fluids and electrolytes. DO NOT use maintenance regimens to correct plasma or blood loss because you can cause a dangerous hyponatraemia. Evaporative losses from skin and respiratory tract, sweat, water and electrolyte losses in urine and faeces: Skin 500, Lungs 400, Urine (0.5ml-1 ml /kg/ hr) 1500, Faeces 100. GUIDELINES Intravenous fluid therapy for adults in hospital: vomiting, diarrhoea, high output stoma, sepsis) as required. Maintenance fluid needs can be estimated using the following general guidelines: Adults: 50 mL/kg/24 hours or 1 mL/lb/h Neonates: 70 to 80 mL/kg/24 h or 2 mL/lb/h These numbers are typically used in all species and are supported by established Adjust rate of IV fluids for current and ongoing deficits Stop routine maintenance fluids when the enteral . Background: Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. fluid loss should be replaced by fluids with a similar electrolyte content to the lost fluid. A prevailing practice is to administer hypotonic fluids as routine maintenance, often as a combination of dextrose 5% in water and 0.45% sodium chloride. That the patient is relatively "normal" {normal size {relatively well {no kidney failure {no heart failure {no electrolyte disturbance {no particular abnormal losses Maintenance Fluid Calculations. According to NCBI guideline, it is recommended to administer maintenance IV fluids required by the patient (30-40ml/kg/day) during day time to ensure good sleep for the patient and nurse. In adults. D5 1/2 NS with 20 mEq KCL/L. For children 11-20 kg the daily fluid requirement is 1000 mL + 50 mL/kg for every kg over 10. Intravenous fluid management is a common medical task, and safe unambiguous fluid prescribing is a required training outcome for junior doctors.1 Despite this, errors in intravenous fluid management are common and have been attributed to inadequate training and knowledge.2 Poor fluid management can result in serious morbidity, such as pulmonary oedema and dangerous hyponatraemia as a result of . So, if the patient had been NPO for 12 hours, they would need 984 ml of fluid to get caught up (82 ml x 12 hours). When a patient is NPO and is on fluids, putting 20 KCL in it will give them about 40-50 per day. the NICE Pathway on nutrition support in adults. However, maintenance fluid also has to be administered. BMI. However, it is thought that 1600 to 2000 mg ( 40 to 50 milliequivalents [mEq]) per day for adults is adequate. Usual water needs should be met with (1) water or (2) low sodium fluids e.g, dextrose or dextrose 4% and 0.18% saline (dextrose-saline) or (3) modest nutrition fluid enterally. 35kg dog: Maintenance = 35kg x 2 = 70mL/hour or 50mL x 35kg = 1750mL/24 hours Maintenance fluid rate for puppy or kitten may be estimated as 3-4mL/kg/hr More detailed guidelines are available in the '2013 AAHA/AAFP Fluid Therapy are 'nil by mouth' (that is, you are not allowed to eat or drink , for example, if you are about to have a general anaesthetic) C. Potassium content: Remember K+ will fall as acidosis corrects with insulin therapy 1. Hypertonic Solutions See figure 1 for the current bedside IV fluid therapy chart. As long as the patient is over 60 kg, just add 40 ml to the weight. fluid solutions supported by limited scientific evidence. For the second 10 kg, 2 mL/kg/hr are administered, and for each additional kg over 20 kg, 1 mL/ What is the common pediatric maintenance fluid? content solutions (saline or Hartmann's solutions) for normal fluid maintenance. Background: Intravenous maintenance fluid (IMF) tonicity and composition influence plasma electrolyte balance. Maintenance fluid can be defined as the amount of fluid required to compensate for ongoing fluid losses, thus maintaining steady state in the body. Maintenance fluid calculations are based on the composition of maintenance water and use the Holiday Segar, or 4:2:1 method Dehydration can be a medical emergency. By term, ECF and intracellular fluid (ICF) volume has fallen to 45% and 30% of TBW . Please note that this calculation does not apply to newborn infants (ie, from 0 to 28 days after full term delivery). Calculate their total fluid requirement over 24 hours: Fluid deficit = 5% dehydration x 12 x 10 = 600 mL. So, this child needs 300 ml of 0.9% saline in the next eight hours (for a total of 500 ml) and another 500 ml in the next 16 hours. Severe dehydration by clinical examination suggests a fluid deficit of 10-15% of body weight in infants and 6-9% of body weight in older children. IV fluids can also be used as maintenance fluids for those who are not able to intake enough hydration throughout the day. If not calculating based on ideal body weight, use clinical judgment for dosing. If patients need IV fluid resuscitation, use crystalloids that contain sodium in the range 130-154 mmol/l, with a bolus of 500 ml over less than 15 minutes. Foals - up to 100ml/kg/day It seems to us that you have your JavaScript disabled on your browser. Holliday-Segar method 6: D5W in 0.2% NaCl with 20 mEq KCl, to run at 100 mL/ hour. Fluid management is a major part of junior doctor prescribing; whether working on a surgical firm with a patient who is nil-by-mouth or with a dehydrated patient on a care of the elderly firm, this is a topic that a junior doctor utilises on a regular basis.. 23/9/2015 Maintenance and replacement fluid therapy in adults Official reprint from UpToDate www.uptodate.com 2015 UpToDate Maintenance and replacement fluid therapy in adults Author Section Editor Deputy Editor Richard H Sterns, MD Michael Emmett, MD John P Forman, MD, MSc All topics are updated as new evidence becomes available and our peer review process is complete. 100 ml/kg/24-hours = 4 ml/kg/hr for the 1st 10 kg 50 ml/kg/24-hours = 2 ml/kg/hr for the 2nd 10 kg 20 ml/kg/24-hours = 1 ml/kg/hr for the remainder Quickchecks Calculate the maintenance water required for a 17kg child? You can do the 4-2-1 Rule in these cases too - the math all works out the same. It can be given by intravenous routes or oral routes (if patient sources of fluid and electrolytes (oral, enteral and drug prescriptions) Monitor and reassess fluid and biochemical status by clinical and laboratory monitoring No No Algorithms for IV fluid therapy in adults 'Intravenous fluid therapy in adults in hospital', NICE clinical guideline 174 (December 2013. Objective: To determine if hypotonic IMF therapy contributes to post-surgical hyponatremia. Pre-existing fluid deficit (replace STAT) 2. help estimate fluid loss. Introducing TOPMAST, the first double-blind randomized clinical trial specifically dedicated to perioperative maintenance fluid therapy in adults. 1. Enter Weight. Maintenance Use saline or a balanced electrolyte fluid, then add required electrolytes. Calculates maintenance fluid requirements by weight. the NICE Pathway on nutrition support in adults. Saline is typically reserved for patients with a sodium level less than 125mEq/l, in disease states such as high potassium, HYPP or renal failure. Variable & Associated Points Maintenance Fluid Rate is calculated based on weight. Intravenous fluid therapy in adults in hospital People in hospital usually get the fluids , salts and sugars they need through eating and drinking, or sometimes through a feeding tube. 2 mL / kg / hour for the second 10kg of body mass (11kg - 20kg) 1 mL / kg / hour for any kilogram of body mass above 20kg (> 20kg). See table 1 for the current fluid solutions commonly used for IV fluid maintenance therapy. Calculating the Maintenance Fluid Rate The 4-2-1 rule is routinely used to calculate the maintenance uid rate for children. This replaces any potential evaporative losses and metabolic requirements. For example, for a 70kg person: 410=40; 210=20; 150=50. Twenty-four hours later, assuming no unusual fluid losses or stimulation of ADH secretion, our patient would weigh the . Participants: Adults who underwent major surgery and received peri-surgical IMF, with exclusive administration of hypotonic pre-mixed 0.33% saline . Maintenance Fluids vs IV Bolus So put KCL patients that are NPO. Long term fluids- need to add potassium, magnesium and calcium for maintenance. the NICE Pathway on nutrition support in adults. 3) Hypodermoclysis Hypodermoclysis is the subcutaneous infusion of fluids. The tonicity of the chosen solutions, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. Other maintenance fluid calculators have been derived and employed, however the "4-2-1" rule remains the most widely used for adults and pediatric populations secondary to its ease of calculation. Body water content changes significantly with age in children. "Maintenance" IV fluids in euvolaemic adults Index: Intravenous fluid therapy Original article by: Michael Tam The easy (autopilot) way: Assumptions: 1. Water with 0.9% sodium stays extracellularly. These are the two methods for calculating pediatric maintenance fluid rates, applied in the case of a child weighing 26 kg. (See "Nutrition support in critically ill patients: An overview" .) Prescribing IV Fluids Guidelines - ADULT 3UHVFULELQJ AdultsIntravenous Fluids for v5.00 - 09/2016 0DW 1R 2IFH0D[ 1R 5HYLHZHG E\ 4XHHQVODQG +HDOWK 0HGLFLQHV 5HJXODWLRQ DQG 4XDOLW\ )OXLG DQG (OHFWURO\WH *XLGHOLQH :RUNLQJ 3DUW\ 7KH 6WDWH RI 4XHHQVODQG 4XHHQVODQG +HDOWK &RQWDFW PHGLFDWLRQVDIHW\#KHDOWK TOG JRY DX 1957; 19: 5) ( 823-332). Guide to Maintenance Intravenous Fluid Therapy in Acutely Ill Patients. = 2500ml water lost . Patients with ongoing losses or abnormal distribution of fluids (e.g. " Mayo Clinic. An introduction to fluid management for adults in hospitals, covering replacement during resuscitation, malnourished patients and following large electrolyte losses. Identification of the degree of deficit is based on patient history and physical signs on exam. Pediatric fluid bolus is 20mL/kg Pediatric blood transfusion dose is 10cc/kg In the ER, I commonly order Intravenous fluid to those with nausea and vomiting, diarrhea, dehydration, acute kidney injury, abdominal pain, headaches, bleeding, or infections. INSTRUCTIONS While originally derived in pediatric patients, this calculator is applicable to any age. The maintenance fluid calculator was derived in 1957 by Holliday and Segar for the pediatric population but has persisted in use for both adults and pediatric patients to date. In adults with a major burn, maintenance fluid should be given in addition to resuscitation fluids. Volume = start at goal for adults/pediatrics based on fluid balance of patient Neonates = usually start lower and advance to goal 100 ml/kg for 1. st. ten kg body weight + 50 ml/kg for 2. nd ten kg body weight + 15 ml/kg for remaining kg body weight One of the primary objectives of maintenance parenteral fluid therapy is to provide water to meet physiologic losses (insensible loss + urine loss). MAINTENANCE IV FLUIDS Thus, for the 24 hours, with administration of 2 to 2.5 L, the patient would receive a so-dium load of 7 to 8.75 g. The consequences Fluid Calculation options Wt (kg) x 30ml = Fluid Requirement Fluid requirements may differ for individuals with cardiac problems, renal failure, dehydration or those requiring restrictions. Twenty-four hours later, assuming no unusual fluid losses or stimulation of ADH secretion, our patient would weigh the . Subtract other sources of fluid intake from the required daily fluid volume to avoid fluid creep (e.g., IV medication, enteral fluids, blood products). Ongoing losses (replace future losses as they occur) 4 cc/hr for kg 1-10 2 cc/hr for kg 11-30 1 cc/hr for each additional kg So for a 70-kg male, the infusion rate would be 40 + 40 + 40 = 120 cc/hr. Types of fluid lost and what they should be replaced with include: table on IV fluid prescription for routine maintenance over a 24-hour period. 4 mL / kg / hour for the first 10kg of body mass The formula states that for the rst 10 kg of body weight, 4 mL of uid are administered per kg, per hour. Give sodium chloride 0.9% (+/-K l) or Hartmann's in addition to routine maintenance fluids as expected. This is usually from diarrhea and vomiting.3 Children become dehydrated more easily as their body surface area compared to their weight is much larger than that of an adult.4 Maintenance fluid is the amount of fluid the body needs to replace usual daily losses from the respiratory Maintenance IV fluids for our nonacutely ill adult patient could be: NICE guideline 5: D5W in 0.2% NaCl with 20 mEq KCl, to run at 75 mL/hour. Water. expert. [1.3.1] Routine maintenance If patients need IV fluids for routine maintenance alone, restrict the initial prescription to: 25-30 ml/kg/day of water and Intravenous fluid management. Prescription in Adults New Adult IV Fluid Prescription Chart Maintenance fluids based on patient's weight & prescribed in ml/hr Types of preferred IV fluids -New fluids being introduced Volume of infusion bags -Change from 500ml to 1L bags New Fluid Balance Monitoring Chart including subtotals and stop & check prompt Ensuring considered fluid and haemodynamic management is central to peri-operative patient care and has been shown to have a significant . If K+ between 4 and 6 mmol/L, give a total of 40 meq/L table on IV fluid prescription for routine maintenance over a 24-hour period. Holliday-Segar method 6: D5W in 0.2% NaCl with 20 mEq KCl, to run at 100 mL/ hour. Daily and globally, millions of adult hospitalized patients are exposed to maintenance i.v. Calculating the maintenance for adults is usually quite easy. Typically, the volume is 2-2.5 litres per day for a fit, young adult. JavaScript is required in order for our site to behave correctly. Why is it different than adult maintenance fluid? sources of fluid and electrolytes (oral, enteral and drug prescriptions) Monitor and reassess fluid and biochemical status by clinical and laboratory monitoring No No Algorithms for IV fluid therapy in adults 'Intravenous fluid therapy in adults in hospital', NICE clinical guideline 174 (December 2013) The volume of maintenance fluid for 24 hours is 1000 ml (100 ml/kg X 10 kg). Consider using ideal body weight in obese patients. Calculating maintenance fluids Daily maintenance fluid requirements (as per NICE guidelines): 25-30 ml/kg/day of water and approximately 1 mmol/kg/day of potassium, sodium and chloride and approximately 50-100 g/day of glucose to limit starvation ketosis (however note this will not address the patient's nutritional needs) 1.4.1 If patients need IV fluids for routine maintenance alone, restrict the initial prescription to: 25-30 ml/kg/day of water and approximately 1 mmol/kg/day of potassium [ 3], sodium and chloride and approximately 50-100 g/day of glucose to limit starvation ketosis. The 4/2/1 rule: 4 ml/kg for first 10kg, 2ml/kg for the next 10kg, 1 ml/kg for every 1kg over 20. The maintenance fluid requirement per kg of weight is higher in children than in adults. Inadequate fluid intake and excessive fluid loss . Adequate hydration is essential for the human body to maintain organ perfusion and cell metabolism. Maintenance fluid rate for an adult dog or cat is estimated as 2mL/kg/hr OR 50mL/kg/24 hours e.g. Estimated maintenance requirements follow the 4/2/1 rule: 4 cc/kg/hr for the first 10 kg, 2 cc/kg/hr for the second 10 kg, and 1 cc/kg/hr for every kg above 20. Last update December 2016) Europe PMC is an archive of life sciences journal literature. - If patients need IV fluids for routine maintenance, follow algorithm 3 (routine maintenance) - If patients need IV fluids to address existing deficits or excesses, ongoing abnormal losses, or abnormal fluid distribution, follow algorithm 4 (replacement and redistribution). Since most hospitalized patients are at risk for hyponatremia from AVP excess, in most acutely ill adults, the safest type . Insensible losses refer to other routes of fluid loss, such as in sweat and from the respiratory tract. Fluid therapy is divided into MAINTENANCE, DEFICIT, and REPLACEMENT requirements. This is similar to the daily requirement method: 100 cc/day for kg 1-10 The type and rate of maintenance fluids (if needed) are based on the patient's fluid and electrolyte requirements (dependent on their weight) Replacement of fluid loss. More information about the two formulas and about maintenance fluid therapy, can be found in the text below the form. Worked example: fluid replacement. Maintenance fluids should address the patient's basic physiologic needs, including both sensible and insensible fluid losses. The daily maintenance fluid is added to the fluid . View diagram of ongoing . On-going fluid loss is added to maintenance fluid to approximate the required fluid intake as closely as possible. common cause of shock in children2 and requires fluid therapy. 1) Daily volume formula: (100 mL for each of the first 10 kg) + (50 mL for each kg between 11 and 20) + (20 mL for each additional kg past 20 kg) = 1,000 mL + 500 mL + 120 mL = 1,620 mL. Patients expected to have inadequate energy or fluid intake for more than one to two weeks should be considered for parenteral or enteral nutrition. If K>6.0 mmol/L, do not add potassium to fluids 2. 4% dextrose/0.18% sodium chloride as maintenance fluid. Includes two components: 1. ENDOCRINE FUNCTIONS Kidneys have primary endocrine function since they produce hormones In addition, the kidneys are site of degradation for hormones such as insulin and aldost If corrected Na 150 mmol/L, use 1/2 NS for maintenance fluid. Please enable JavaScript to use our site. In particular, it remains unclear whether fluid tonicity contributes to the recently established detrimental effects of fluid, sodium, and chloride overload. The IV maintenance fluid calculator is a tool addressed to clinicians that need to determine . Maintenance fluids 421 rule calculator "421 rule" Rate of crystalloid per hour= 4mL/kg for first 10kg (40) +2mL/kg for next 10kg (+20) +1mL/kg for every next kg (+ (wt - 20 kg)) E.g. Traditional maintenance fluids in children are quite hypotonic, with 0.2 NS or 1/4 NS being used in children less than 10-20 kg and 1/2 NS in larger children. The 421 rule is used to calcuate the hourly infusion rate for maintenance fluids (generally just for pediatrics). What is the common adult maintenance fluid?
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