A 20 kg child requires maintenance IV fluids. Using Holliday-Segar, what is the approximate total daily maintenance in mL?

• A. 1000 mL/day.
• B. 1500 mL/day.
• C. 2000 mL/day.
• D. 2500 mL/day.

Answer: (B)

Maintenance fluid needs in pediatrics are estimated with the Holliday-Segar method, which uses weight-based tiers to set daily needs. For the first ten kilograms, about one hundred milliliters per kilogram per day are needed. For the next ten kilograms (from ten to twenty kilograms), about fifty milliliters per kilogram per day are needed. For any weight above twenty kilograms, about twenty milliliters per kilogram per day apply.

A child weighing twenty kilograms sits at the boundary between the first and second tiers. Calculate the contribution from each tier: ten kilograms at the hundred mL/kg/day rate gives one thousand milliliters per day, and the next ten kilograms at fifty mL/kg/day gives five hundred milliliters per day. Add them together and you get one thousand five hundred milliliters per day, roughly one and a half liters.

This is an approximate maintenance value; adjustments may be needed for fever, losses from vomiting or diarrhea, or other factors.