Pediatrics

Pediatric Maintenance Fluids (Holliday-Segar) & Dehydration Deficit

Calculates 24-hour and hourly maintenance fluids (4-2-1 rule), dehydration fluid deficit, and emergent bolus volume.

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Parameters

Pediatric Maintenance Fluids (Holliday-Segar) & Dehydration Deficit Result

Formula

Holliday-Segar 4-2-1 Rule:
• 1st 10 kg: 4 mL/kg/hr (100 mL/kg/day)
• 2nd 10 kg: +2 mL/kg/hr (+50 mL/kg/day)
• > 20 kg: +1 mL/kg/hr (+20 mL/kg/day)
Deficit Replacement: 50% over first 8 hours + 50% over next 16 hours.

Clinical Pearls

Foundational pediatric calculation that prevents fluid overload and hyponatremic brain injury while ensuring physiological organ perfusion.

Limitations

Fluid restriction (e.g., 50–70% of maintenance) is required in SIADH, acute oliguric renal failure, congestive heart failure, and post-neurosurgery.