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Nursing
Calculating Maintenance Fluid Rates
Although it is the physicians responsibility to calculate and order daily uid requirements for
patients, Registered Nurses are responsible for double checking the order for accuracy. Below are
two different methods used in calculating paediatric maintenance uid rates.
Formula Method
(100 ml for each of the rst 10kg) + ( 50ml for each kg 11-20) + (20 ml for each additional kg) /
24hour
Example:
Calculate the hourly maintenance uid rate for a child
who weighs 25kg
(100mL x 10kg) + (50mL x 10kg) + (20mL x 5kg) / 24hrs
(1000mL) + (500mL) + (100mL) = 1600mL / 24hrs =
66.7ml/hr
Using this formula the hourly uid maintenance for this
child is 67mL/hr
4 / 2 / 1 Method
(4ml/kg for the rst 10kg) + (2ml/kg for kg 11-20) + (1ml/kg for every kg above 20) = hourly rate
Example:
Calculate the hourly maintenance uid rate for a child
who weighs 25kg
(4ml x 10kg) + (2ml x 10kg) + (1ml x 5kg) = hourly rate
40ml + 20ml + 5ml = 65ml/hr
Using the 4/2/1 method, this child's hourly maintenance
uid rate is 65mL/hr
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http://www.sickkids.ca/Nursing/Education-and-learning/Nursing-Student-Orientation/module-two-clinical-care/paediatric-iv-therapy/Calculating-Maintenance-Fl 1/1
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Intravenous uids
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
Background:
Whenever possible the enteral route should be used for uids. These guidelines only apply to children who
cannot receive enteral uids.
The safe use of IV uid therapy in children requires accurate prescribing of uid and careful monitoring
Always check orders that you have written, and ensure that you double check on orders written by other staff
when you take over the child's care
Incorrectly prescribed or administered uids are potentially very dangerous. More adverse events are
described from uid administration than for any other individual drug. If you have any doubt about a child's uid
orders - ask a senior doctor.
Remember to check compatibility of intravenous uid with any intravenous drugs that are being coadministered.
Maintenanceplus
Decit(dehydration guidelines), plus
Ongoing losses(dehydration guidelines)
Maintenance
This guideline should be used as a starting point and will need to be adjusted in ALL unwell children.
http://www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/
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Generally 2/3 of maintenance rate should be used in unwell children unless they are dehydrated. This is because they
are likely to be secreting anti-diuretic hormone (ADH), so will need less uid. Children with meningitis or other acute
CNS conditions will likely require additional uid restriction seek senior advice.
For uid options in the dehydrated child see dehydration guidelines.
Weight (kg)
20
13
10
40
27
15
50
33
20
60
40
25
65
43
30
70
47
35
75
50
40
80
53
45
85
57
50
90
60
55
95
63
60
100
67
REMEMBER to consider decit and ongoing losses - especially in severe gastroenteritis, if there are drain losses,
ileostomies etc.
Which Fluid?
Some good uid solutions for sick children include:
Fluid
Alternative
names
Uses
Normal
saline
Initial boluses
Replacement of decit
Replacement of losses
Maintenance hydration
http://www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/
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Replacement of decit
Replacement of losses
Normal
saline with
glucose
Maintenance
Replacement of decit
Replacement of losses
Consider whether potassium is required in the uid. This should be avoided, if possible, unless premade uid
bags containing potassium are available. Adding potassium to bags of uid on the ward is a safety risk.
Hypotonic uid (containing a sodium concentration less than plasma) is no longer recommended in children. These
uids have been associated with morbidity/mortality secondary to hyponatraemia. Fluids that should NOT be given
include:
0.18% NaCl with 4% glucose +/- KCl 20mmol/L (or 4% and 1/5 NS) should NOT be given
Monitoring
All children on IV uids should be weighed prior to the commencement of therapy, and daily afterwards. Ensure
you request this on the treatment orders.
Children with ongoing dehydration/ongoing losses may need 6 hourly weights to assess hydration status
All children on IV uids should have serum electrolytes and glucose checked before commencing the infusion
(typically when the IV is placed) and again within 24 hours if IV therapy is to continue.
For more unwell children, check the electrolytes and glucose 4-6 hours after commencing, and then according
to results and the clinical situation but at least daily.
Pay particular attention to the serum sodium on measures of electrolytes. If <135mmol/L (or falling signicantly
on repeat measures) see Hyponatraemia Guideline. If >145mmol/L (or rising signicantly on repeat measures)
see Hypernatraemia guideline.
Children on iv uids should have a uid balance chart documenting input, ongoing losses and urine output.
Special uids
Outside the newborn period, do not use these uids apart from exceptional circumstances and check the
serum sodium regularly
10% Dextrose
Used in neonates (sometimes with additional NaCl). Used in ICU for patients under 12 months (with 0.45% saline).
Sometimes used by infusion in neonates and children with metabolic disorders. Check blood glucose regularly.
15-20% Dextrose
Very occasionally used by infusion in children with metabolic disorders. Check blood glucose regularly.
25% and 50% Dextrose
Rarely required in children, misuse can cause severe adverse events.Only used in discussion with senior staff as
bolus or low volume infusions (1-2 ml/hr) to correct refractory hypoglycaemia.
http://www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/
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-Children requiring care above the level of comfort of the local hospital.
-Severe electrolyte or glucose abnormalities
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency
Retrieval (PIPER) Service: 1300 137 650.
Information Specic to RCH
From February 2016, Plasma-Lyte148 and 5% Glucose will be the standard maintenance uid prescribed.
0.45% sodium chloride and 5% glucose +/- KCl (or 5% and NS) should NOT be given.
Children on intravenous uids need daily electrolyte monitoring.
20-50% dextrose should not be given outside the ICU or NNU setting without discussion with a consultant.
mls/hour
3 to 10kg
100 x wt
4 x wt
10 - 20kg
40 plus 2 x (wt-10)
>20kg
Additional notes
There is often confusion about the difference between oral and iv uid requirements for young infants. The water
requirement is identical for both routes of administration. The relatively low energy density of milk means that infants
need 150-200mls/kg/day to obtain adequate nutrition. That is why they pass more dilute urine than older children.
Contentauthorisedby:Webmaster.Enquiries:Webmaster.
http://www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/
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HowtocalculateIVflowrates:
Intravenousfluidmustbegivenataspecificrate,neithertoofastnortooslow.Thespecificratemaybe
measuredasml/hour,L/hourordrops/min.Tocontroloradjusttheflowrateonlydropsperminuteareused.
Theburettecontainsaneedleorplasticdropperwhichgivesthenumberofdropsperml(thedropfactor).A
numberofdifferentdropfactorsareavailable(determinedbythelengthanddiameteroftheneedle).
Commondropfactorsare:
10drops/ml(bloodset),15drops/ml(regularset),60drops/ml(microdrop).
Tomeasuretheratewemustknow:
(a)thenumberofdrops
(b)timeinminutes.
Theformulaforworkingoutflowratesis:
volume(ml)Xdropfactor(gtts/ml)
=gtts/min
(flowrate)
time(min)
Example:
1500mlIVSalineisorderedover12hours.Usingadropfactorof15drops/ml,howmanydropsper
minuteneedtobedelivered?
1500(ml)X15(gttss/ml)
=31gtts/minute
12x60(givesustotalminutes)
http://www.unc.edu/~bangel/quiz/testivh.htm
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