FLUIDS

(COMPUTATION)
CHED COLEEN GAY G. F LORES-UY, M.D.

MAINTENANCE WATER RA TE
 0-10 kg: 4 mL/kg/hr
 10-20 kg : 40 mL/hr + 2mL/kg/hr x (wt-10kg)
 >20 kg: 60 mL/hr + 1mL/kg/hr x (wt-20kg)

BODY WEIGHT METHOD F OR CALCULATING MAINTENANCE FLUID VOLUME

(HOLIDAY SEGAR METHO D)

Body Weight Fluid per Day

 0-10 kg: 100 mL/kg

 11-20 kg: 1,000 mL + 50 mL/kg for each kg >10 kg
 >20 kg: 1,500 mL + 20 mL/kg for each kg >20 kg

*The maximum total fluid per day is normally 2, 400 mL*

FACTORS MODIFYING FLUID REQUIREMENTS

Condition Adjustment Needed

Extra Needed
Fever 12% for each ˚C > 37.5 ˚C
24% for each ˚C > 38.5
Sustained hyperventilation or excessive muscular activity as 25-50%
in seizures, chills
Hypermetabolic states:
 Severe thermal injury, salicylate intoxication, 25-75%
thyrotoxicosis
 Burns on the 1st day (4% increase per 1% area burnt),
subsequent days 2% increase per 1% area burnt

Abnormal water and electrolyte losses as in diarrhea and Volume per volume
vomiting
Sweating 10-25%
Room Temperature 30% per ˚C rise
Newborn under radiant warmer or phototherapy 25%
Full activity and oral feeds 50%
Less required
Hyperthermia 12% per each ˚C below 37.5˚C
Very high humidity 30%
Humidified inspired air 25%
Oliguria or anuria Case to case basis due to reduced energy expenditure
Edematous and anti-diuretic states 30%

KGB
 TYPES OF IVF

Type Glucose Na+ K+ Ca+2 Cl- Lactate PO4-3 Mg+2 Others

Hypotonic

D5W 50 0 0 0 0 0 0 0 - Drowning, ascites, CHF, HTN,

azotemia
D5NM 50 40 13 - 40 - - 3 Acetate:26 Maintenance in adults
D5 0.3% Nacl 50 51 0 0 51 0 0 0 - Asthma, fever, sweating
D5IMB 50 25 20 - 22 - 3 3 - Maintenance in pedia
Isotonic
D5LR 50 130 4 3 109 28 0 0 - LBM, burns, profuse bleeding
D5NSS 50 154 0 0 154 0 0 0 - Vomiting, UTI, heat stroke
D5NR 50 140 5 - 98 - - 3
PNSS 0 154 0 0 154 0 0 0 - DM, Hypovolemic Shock
Hypertonic
D10W 100 0 0 0 0 0 0 0 - Ascites, increased BUN
D5 0.3% NaCl alternate with D5LR : DF, seizure

ASSESSMENT OF PATIENTS FOR DEHYDRATION

A B C
Look at Condition Well, alert Restless, irritable Lethargic or unconscious
Eyes Normal Sunken Sunken
Thirst Drinks normally, not thirsty Thirsty, drinks eagerly Drinks poorly, or not able to drink
Feel Skin Pinch Goes back quickly Goes back slowly Goes back very slowly
Decide No dehydration Some dehydration Severe dehydration

No dehydration Some dehydration Severe dehydration

<2 years old 5% (50 x wt) 10% (100 x wt) 15% (150 x wt)
> 2 years old 3% (30 x wt) 6% (60 x wt) 9% (90 x wt)

SAMPLE QUESTION: Wt: 9kg MF: 0-10kg= 100 mL/kg

A 1yo child weighing 9kg was seen by the ER physician with 100 x 9 = 900mL
history of vomiting and LBM. He has sunken eyeballs and
Deficit: Moderate DHN = 100 x wt (9) = 900 mL
sunken fontanelles. He was noted to be thirsty. Compute for
the total fluid requirement.
MF + Deficit = 900 + 900 = 1800 mL/day or 75 mL/hr

KGB