Formulas Used:
- For 0 – 10 kg = weight (kg) x 100 mL/kg/day.
- For 10-20 kg = 1000 mL + [weight (kg) x 50 ml/kg/day]
- For > 20 kg = 1500 mL + [weight (kg) x 20 ml/kg/day]
How do you calculate pediatric maintenance fluid rate?
These are the two methods for calculating pediatric maintenance fluid rates, applied in the case of a child weighing 26 kg. 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.
How do you calculate a fluid bolus?
A fluid bolus is given to fill the vascular bed quickly and is given mostly in the presence of hypovolemic shock. In children, the amount of fluid given in bolus can be calculated using the formula: bolus fluids = weight (kg) * 20 ml with the maximum limit of 1000 milliliters = 1 liter.
How many ml of fluid is in a pediatric bolus?
The answer: the amount of daily pediatric maintenance fluids is 1200 ml, and the hourly demand is 48 ml. Pediatric fluid bolus A term ' bolus ' means an intravenous dose of a drug given relatively quickly, and very often directly from hand.
How do you calculate fluid per kg of blood?
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. Fluid rate = 1,620 / 24 = 68 mL (67.5). 2) 4 – 2 – 1 rule:
How do you calculate IV fluid bolus?
Formulas Used: For 0 - 10 kg = weight (kg) x 100 mL/kg/day. For 10-20 kg = 1000 mL + [weight (kg) x 50 ml/kg/day] For > 20 kg = 1500 mL + [weight (kg) x 20 ml/kg/day]
What is the normal IV bolus rate for a pediatric patient?
Fluid bolus should be rapidly infused at 10 to 20 mL/kg of isotonic saline (0.9%). [2] This should be infused over 20 minutes in children with moderate dehydration and as fast as possible in the presence of severe dehydration.
How do you calculate pediatric IV fluids?
Daily fluid requirements. ... Fluid requirements per hour: Daily fluid requirements are divided into approximate hourly rates which gives the "4-2-1" formula often used to calculate hourly infusion rates of IV fluids. ... Example: A 35 kg child minimum hourly fluid intake would be: (4x10) + (2x10) + (1x15) = 75 cc/hour.Table 2.
What is the 4 2 1 rule for maintenance fluids?
In anesthetic practice, this formula has been further simplified, with the hourly requirement referred to as the “4-2-1 rule” (4 mL/kg/hr for the first 10 kg of weight, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for each kilogram thereafter.
How much is a bolus?
A volume of 250 ml defines a fluid bolus, with a range from 100 ml to >1000 ml, and speed of delivery from stat to 60 minutes.
What type of fluid bolus should be given to a dehydrated child?
Isotonic fluid boluses (NS) are the initial approach to the child with moderate to severe dehydration. A bolus is 20 ml/kg (maximum 1 liter). This is typically given over 20 minutes in the child with moderate dehydration and as fast as possible in the child with severe dehydration.
How are pediatric medications calculated?
Most drugs in children are dosed according to body weight (mg/kg) or body surface area (BSA) (mg/m2). Care must be taken to properly convert body weight from pounds to kilograms (1 kg= 2.2 lb) before calculating doses based on body weight.
How do you calculate pediatric dehydration rate?
After clinical signs have been observed, the degree (%) of dehydration should be determined. This is calculated by dividing the difference between the pre-illness and illness weights by the pre-illness weight, then multiplying by 100 (Table 5). For example, a 10-kg patient who has lost 1 kg is 10% dehydrated.
How do you calculate total fluid intake?
Determination of Fluid Needs Fluid needs for an individual can be calculated as 1 ml/kcal or 35 ml/kg usual body weight (UBW). Patients who have large water losses through perspiration or oozing wounds may require more fluids.
How do you calculate IV fluid rates?
The formula to calculate how many hours will it take for the IV to complete before it runs out is: Time (hours) = Volume (mL) Drip Rate (mL/hour) . The volume of the fluid is 1 000 mL and the IV pump set at 62 mL/hour.
How do you calculate 24 hour IV fluid maintenance?
The 24-hour number is often divided into approximate hourly rates for convenience, leading to the "4-2-1" formula.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.
What is a normal IV fluid rate?
Normal daily fluid and electrolyte requirements: 25–30 ml/kg/d water 1 mmol/kg/day sodium, potassium, chloride 50–100 g/day glucose (e.g. glucose 5% contains 5 g/100ml). Stop IV fluids when no longer needed.
How fast can I run a bolus?
Generally a bolus is run at 999/hour on the pump and we do not know how much fluid is to be given bolus, so we cannot tell you how much volume to infuse.
How many mL HR is a bolus?
Bolus feeding is a common term used to describe tube feeding delivered in 200 – 400 mL volumes over a short period of time (not less than 10 – 15 minutes) using a 60 mL open syringe with gravity.
What is the most appropriate method of delivering rapid fluid boluses to a pediatric patient?
The disconnect-reconnect and push-pull techniques are probably the most common ways of administering fluid boluses in pediatrics.
What is the most appropriate amount to administer for the first normal saline fluid bolus?
Current recommendations are to administer 20 mL/kg of fluid as a bolus over 5 to 10 minutes and repeat as needed.
How much fluid should be given for a bolus?
Parental fluid administration includes bolus and maintenance rates. Fluid bolus should be rapidly infused at 10 to 20 mL/kg of isotonic saline (0.9%).[2] This should be infused over 20 minutes in children with moderate dehydration and as fast as possible in the presence of severe dehydration. A hypotonic fluid or dextrose-containing fluid should not be used for bolus unless the rapid correction of hypoglycemia is needed. A single 20-mL/kg bolus improves circulation but cannot normalize the hemodynamic status. Therefore, it can be repeated as needed until adequate perfusion is restored with careful monitoring of the clinical condition and vital signs. An improvement in clinical status and resolution of signs of dehydration, such as tachycardia and dry mucous membranes, can be easily monitored. A fluid requirement of more than 60 ml/kg without improvement in clinical status indicates other causes such as septic shock or hemorrhage.
How is fluid administration determined?
The fluid administration rate is determined by maintenance requirements, estimated fluid deficit, and ongoing fluid losses. The maintenance rate can be calculated using the Holiday-Segar method.[11] This estimates physiologic losses of water scaled to the metabolic rate based on the weight of the child. The recommended rates are the following: 100 ml/kg for the initial 10 kilograms of weight, 50 ml/kg for each kg between 10-20 kg, 20 ml/kg for each additional kg. [11]
How much rehydration is recommended for a patient?
The recommended rate is 50 mL to 100 mL/kg over 2 to 4 hours for oral fluids.[10] It is recommended to use an oral rehydration solution rather than free water or commercial sports drink.[10] Nasogastric administration is another route for rehydration with similar rates and fluids recommended for oral administration. The implementation of an evidence-based algorithm based on the clinical dehydration score can decrease the frequency of intravenous fluid administration and reduce emergency room length of stay.
Why is oral fluid replacement preferred in children?
This causes extracellular fluid depletion through either diarrhea or vomiting. Oral fluid replacement is preferred in children in mild to moderate dehydration unless any contraindication exists. The intestinal solute transport mechanisms develop the osmotic gradients due to the movement of electrolytes and nutrients through the cell. The passive movement of water follows this. The transport of sodium and glucose occurs at the intestinal brush border.
Why is fluid management important in children?
Early and appropriate fluid administration improves outcomes and reduces mortality in children. Water is essential for cellular homeostasis. There are two major fluid compartments: the intracellular fluid (ICF) and the extracellular fluid (ECF). Two-thirds of the total body water (TBW) is intracellular. The TBW varies with age; 70% in infants, 65% in children, and 60% in adults. The human body has a strict physiologic control to maintain a balance of fluid and electrolytes. However, in disease states, these mechanisms may be overwhelmed. Dehydration occurs due to significant depletion of water and electrolytes. It commonly increases morbidity and mortality in children. Infants and young children are quite sensitive to even a small degree of dehydration. This may be due to:
Why is IV fluid more effective?
In such situations, an IV fluid administration may be more efficient for rehydration. This may be more relevant in infants and young children, especially if there is vomiting associated with diarrhea. Oliguria also indicates that dehydration is severe, and requires intravenous fluids.
What is the sodium level of normal saline?
Normal saline has plasma sodium of 154 mEq/L and 1/2 and 1/4 normal saline are a fraction of 154 mEq/L.
Calculating a Bolus Dose for Carbohydrate (Meal Bolus)
ICR is the amount of rapid-acting insulin (I) you need for a specific amount of carbohydrate (C) in food. This is the number of grams of carbohydrates that 1 unit of rapid-acting insulin will cover. Example: 1 unit of rapid-acting insulin will cover 10 grams carbohydrates. This may also be written 1:10.
Calculating a Bolus Dose for High Blood Glucose (Correction Bolus)
Correction factor is how much 1 unit of rapid-acting insulin will reduce the blood glucose number.
Rounding Insulin Doses
We will tell you if you need to round to whole units or half units. You may be told to use a different correction factor at bedtime or during the night.
Why is fluid and electrolyte therapy important?
Fluid and electrolyte therapy is an essential component of the care of hospitalized children, and a thorough understanding of the changing requirements of growing children is fundamental in appreciating the many important pharmacokinetic changes that occur from birth to adulthood. While there are many factors that contribute to the fluid and electrolyte needs of children, approaching this therapy in a systematic, organized fashion can help pharmacists meet ongoing as well as changing needs of the patient. Organizing fluid therapy into maintenance, deficit, and replacement requirements, and then monitoring the patient for response to therapy makes fluid therapy manageable.
How does fluid therapy affect drug therapy?
Fluid therapy can also have an impact on drug therapy. Hydration status can affect the dose needed to achieve therapeutic concentrations, and dehydrated patients may be at risk for toxicity if standard doses of drugs with high volumes of distribution are used. Monitoring fluid and electrolyte therapy is an important role of the pediatric pharmacist.
What is the Holliday-Segar equation?
The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements.
How much weight do babies lose after birth?
After birth, infants are expected to lose approximately 5%-15% of their body weight, with more being lost in low birth weight infants.2,3In fact, if this weight loss does not occur, there is cause for concern for renal dysfunction and sepsis.
What causes a higher evaporative loss?
Congenital abdominal wall defects such as omphalocele and gastroschisis can lead to higher evaporative losses before surgical correction, and thus careful attention should be paid to fluid balance and electrolytes. There are many mechanisms of determining the maintenance fluid requirements for children.
Why are children's requirements higher than adults?
First, the higher metabolic rate of children requires a greater caloric expenditure, which translates into higher fluid requirements.6Secondly, children, especially infants, have a much higher body surface area to weight ratio, and this translates into relatively more water loss from skin compared with adults. In addition, children, especially infants, have higher respiratory rates,8and this equates to higher insensible losses from the respiratory tract (Table 1).
How much water does a baby have at 24 weeks?
Total body water content changes drastically from before birth until one year of age. At 24 weeks gestational age, a baby's total body water content is close to 80% of total body weight.1This slowly decreases until the child is around one year of age, when total body water content is about 60% of total body weight.2Most adults' total body water is between 50% and 60% of total body weight.2
What should be assessed for volume status?
The volume status of the child should be assessed looking for features of clinical dehydration or shock.
What are the indications for IV fluids in infants and children?
Broadly there are three indications for IV fluids in infants and children: routine maintenance, replacement and resuscitation. 1.
When are boluses required?
Boluses of fluid are required if the patient is shocked or haemodynamically compromised.
Which route is preferred for fluids in infants and children?
In infants and children, the oral or nasogastric route for fluids is preferred where possible.
What does hypotension mean in a child?
Hypotension is a sign of decompensated shock and indicates that the child is critically unwell.
How old is neonatal period?
There are different formulae for patients in the neonatal period, which is up to 28 days of age, and for those who are older.
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What is the requirement for IV fluids calculator?
The only requirement in the IV maintenance fluids calculator is to input the weight of the pediatric patient in either kg or lbs. Given that the formulas use kg as standard weight unit, lbs will be transformed to kg.
How does this IV maintenance fluids calculator work?
This health tool estimates the fluid requirement in the case of pediatric patients based on the formulas beyond the Holliday-Segar nomogram and the 4 – 2 – 1 rule.
Why is fluid therapy important?
Fluid therapy is instituted in order to preserve the normal volume of body fluids and their electrolyte composition. The two components are homeostasis preserving maintenance and repletion.
What is the most common cause of dehydration in pediatric patients?
The most common cause of dehydration in pediatric patients is diarrheal fluid loss. In these cases, depending on the maintained serum sodium level (normal range between 135 – 145 mEq/L), electrolyte loss can vary from isotonic to hypo-osmolar.
What is the minimum weight for a newborn?
Please note that the calculator cannot be applied to newborns (0 – 28 zile after full term pregnancy), therefore the minimum weight value to input is 3.5 kg.
Does fluid loss occur in infants?
Usually fluid loss takes place at a normal rate, however, febrile infants and children have a greater transcutaneous evaporative water loss.
What is the preferred initial maintenance fluid for a child in the ICU?
Since almost all children in an ICU will have at least one stimulus for ADH production, isotonic fluid is generally the preferred initial “maintenance” fluid (NS or LR), unless there is a specific contraindication such as hypernatremia or volume overload.
How often should I give a child with AKI a urine replacement solution?
Hence, urine replacement solution (D5 1/2 NS) should be given to replace urinary losses as they occur (ml/ml every 4 hours). This is especially important in the child with AKI, since it prevents the development of intravascular volume depletion if the child’s urine output increases.
What is the best fluid for oliguria?
The basic strategy for managing the patient with oliguria is to provide maintenance fluids at a rate that replaces insensible losses (typically 1/3 of maintenance in children less than 20 kg and 1/4 of maintenance in children >20 kg). D5 or D10 1/2 NS is a good choice, with the caveat that potassium can be added in the child without renal failure or if the potassium level is low. D10 1/2 NS may be appropriate if the child has no other source of dextrose, since low rate will decrease the dextrose if the patient only receives traditional D5.
Why is maintenance fluid important?
Maintenance fluid is based on replacing fluid/electrolytes due to insensible losses (principally water losses from the skin and lungs) and urinary losses of water and electrolytes. Gastrointestinal losses are considered negligible in the absence of a pathologic process, such as diarrhea. Providing maintenance fluids in the presence of anuria due to chronic renal failure will quickly cause volume overload. Similarly, the patient with nephrogenic diabetes insipidus will rapidly become dehydrated if only given maintenance fluids.
What is the potassium composition of maintenance fluids?
The traditional potassium composition of maintenance fluids is 20 mEq/L. This is generally effective in preventing hypokalemia, but not causing hyperkalemia. However, this strategy was developed for the healthy child with normal kidney function.
What are maintenance fluids?
Maintenance fluids consist of water, glucose, sodium, and potassium. The glucose prevents starvation ketoacidosis and decreases the likelihood of hypoglycemia. Water, sodium and potassium protect the patient from dehydration and electrolyte disorders.
How much water does fever need?
Fever is expected to increase maintenance water needs by 10-15% for each degree over 38 degrees. There are also formulas for adjusting fluid therapy in burns based on the size of the patient and size of the burn. Pulmonary losses are decreased in the intubated child, who may thus need a lower insensible fluid rate in the presence of anuria/oliguria.
