Pediatric Maintenance Fluid Calculator (Holliday-Segar)
Enter the body weight: the tool applies the Holliday-Segar (1957) maintenance schedule — first 10 kg × 100 mL/kg/day, next 10 kg × 50 mL/kg/day, and > 20 kg × 20 mL/kg/day — and converts to an mL/hr infusion rate. The bedside "4-2-1 mL/kg/hr" mnemonic value is shown alongside for sanity-checking. Intended for normally-hydrated paediatric inpatients without ongoing losses; dehydration deficit, vomiting / diarrhoea, burns, cardiopulmonary disease and SIADH all need separate adjustment.
Common age / weight presets
Enter a valid weight (0.5 – 150 kg).
Result
Maintenance IV rate
—
mL/hr
Daily total
—
mL/day
4-2-1 bedside rate (mL/hr)
—
Bedside mnemonic: first 10 kg × 4 mL/kg/hr, next 10 kg × 2 mL/kg/hr, remainder × 1 mL/kg/hr. Differs slightly from mL/day ÷ 24 because 100/24 ≈ 4.17.
Per-tier breakdown (mL/day)
- First 10 kg × 100 mL/kg —
- Next 10 kg × 50 mL/kg —
- > 20 kg × 20 mL/kg —
For clinical use, follow institutional guidance. This calculation gives baseline maintenance only — it does not account for dehydration deficit or ongoing losses (vomiting, diarrhoea, drains). SIADH risk, post-operative, cardiac, pulmonary and burn patients usually need adjusted rates — see your local protocol (e.g. NICE NG29 in the UK, AAP 2018 in the US).
Formula
First 10 kg : 100 mL ⁄ kg ⁄ day 10 – 20 kg : 50 mL ⁄ kg ⁄ day (add) > 20 kg : 20 mL ⁄ kg ⁄ day (add) mL ⁄ hr = mL ⁄ day ÷ 24 Bedside 4-2-1: first 10 kg × 4 + next 10 kg × 2 + remainder × 1 (mL ⁄ kg ⁄ hr)
- · Weight → daily-volume quick reference: 5 kg → 500 mL; 10 kg → 1,000 mL; 15 kg → 1,250 mL; 20 kg → 1,500 mL; 30 kg → 1,700 mL; 50 kg → 2,100 mL; 70 kg → 2,500 mL.
- · The bedside 4-2-1 hourly rule does not exactly match mL/day ÷ 24: 100/24 ≈ 4.17, 50/24 ≈ 2.08, 20/24 ≈ 0.83. Example (15 kg): 4-2-1 hourly = 50 mL/hr; mL/day ÷ 24 = 52.1 mL/hr — about 4 % apart, clinically equivalent.
- · This tool reports baseline maintenance only — it does not add dehydration deficit (computed from % body weight loss), ongoing losses (vomiting, diarrhoea, drains, burn evaporation), or fever (≈ +12 % per °C above normal). Add these to the maintenance rate as needed.
- · Fluid composition: NICE NG29 (2015, updated 2020) recommends isotonic fluids (e.g. 0.9 % NaCl or Plasmalyte) for most paediatric inpatients to reduce the risk of hyponatraemia; hypotonic solutions (e.g. 0.18 % NaCl) are reserved for specific indications.
- · Situations requiring restriction: SIADH (meningitis, post-operative), heart failure, pulmonary oedema, acute kidney injury, and the first 24 h post-burn (where Parkland is used instead) typically use 2/3 maintenance or less — defer to local protocol.
- · References: Holliday MA, Segar WE. Pediatrics. 1957;19(5):823–832 (original); NICE Guideline NG29 "Intravenous fluid therapy in children and young people in hospital" (2015, 2020 update); American Academy of Pediatrics Clinical Practice Guideline, Pediatrics. 2018;142(6) — isotonic maintenance fluid recommendation.
Frequently asked
Does the Holliday-Segar formula apply to adults too?
Partially — with caveats. The original 1957 paper validated the formula in a paediatric range (0 – 30 kg), aligning fluid need to metabolism (≈ 100 mL per 100 kcal). Extending it linearly to adults gives 70 kg → 2,500 mL/day, which sits within the usual 2,000 – 2,500 mL/day adult reference. But beyond ~80 kg the formula tends to over-estimate need — e.g. 100 kg → 3,100 mL/day is generally too much. Adult inpatient fluid orders more often use 30 – 35 mL/kg/day or 1 mL/kcal, and many institutions calculate against ideal body weight rather than actual weight to avoid over-resuscitating obese patients. For adults > 80 kg, switch to an adult-specific formula and follow your local guideline.
Why do current guidelines recommend isotonic (0.9 % NaCl) instead of the older 0.18 % saline + 5 % dextrose mix?
Because three decades of evidence have shown that hypotonic maintenance fluids significantly raise the risk of hospital-acquired hyponatraemia, especially when ADH is elevated — post-operative, lower-respiratory infection, CNS infection. From 2007 onwards a series of RCTs (Choong, Friedman, McNab and others) demonstrated that isotonic fluids (0.9 % NaCl or Plasmalyte with 5 % dextrose) cut the incidence of hyponatraemia by about 50 – 80 % without increasing hypernatraemia. NICE NG29 (2015) and the American Academy of Pediatrics (2018) now both list isotonic as the standard maintenance fluid in children. This calculator computes *volume* only — it does not prescribe a composition; choose the isotonic preparation recommended by your institution when writing the order.
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