This document discusses three methods for calculating maintenance fluid requirements: the caloric expenditure method, Holliday-Segar method, and body surface area method. The caloric expenditure method estimates fluid needs based on calories metabolized, with 100-120mL of water needed per 100 calories. The Holliday-Segar method estimates needs based on weight categories. The body surface area method relates caloric expenditure to body surface area. An example calculation is provided for a 2-year old child using each method.

1. Maintenance Fluid Calculation
1.Caloric Expenditure method
This method is effective for all ages, types of
body habitus, and clinical states.
-For each 100 calories metabolized in 24 hr, the
average patient will need 100–120 mL H2O, 2–
4 mEq Na+, and 2–3 mEq K+
-Adjust caloric expenditure needs by various
factors (e.g., fever, activity)
.

2. Caloric Expenditure Method
AVERAGE WATER AND ELECTROLYTE REQUIREMENTS PER 100 CALORIES PER 24 HOURS
Clinical State H2O (mL) Na+ (mEq) K+ (mEq
Average patient receiving parenteral fluids[*] 100–120 2–4 2–3
Anuria 45 0 0
Acute CNS infections and inflammation 80–90 2–4 2–3
Diabetes insipidus Up to 400 Var Var
Hyperventilation 120–210 2–4 2–3
Heat stress 120–240 Var Var
High-humidity environment 80–100 2–4 2–3
Reference -Harriet lane

3. Maintenance Fluid Calculation
2. HOLLIDAY-SEGAR METHOD
Estimates caloric expenditure in fixed weight
categories; it assumes that for each 100
calories metabolized, 100 mL of H2O will be
required.
-Holliday-Segar method is not suitable for
neonates < 14 days old; generally, it
overestimates fluid needs in neonates
compared with the caloric expenditure
method

4. Fluid Requirements in:
Infants and Children
HOLLIDAY-SEGAR METHOD
First 10kg 100ml/kg
(4ml/kg/hr)
Na+3
10-20kg 1000ml + 50ml/kg for each Kg>10kg
(40ml/hr+2ml/kg/hr(wt-10kg)
K+2
>20kg 1500ml +20ml/kg for each Kg>20kg
(60ml/hr + 1ml/kg/hr( wt-20 kg)
Cl-2

5. Maintenance Fluid Calculation
3. BODY SURFACE AREA METHOD
-Based on the assumption that caloric
expenditure is related to BSA
-It should not be used for children <10 kg

6. Body Surface Area Method
STANDARD VALUES FOR USE IN BODY SURFACE AREA METHOD
H2O 1500 mL/m2/24 hr
Na+ 30–50 mEq/m2/24 hr
K+ 20–40 mEq/m2/24 hr
Reference- Harriet lane

7. SAMPLE ESTIMATED ENERGY REQUIREMENTS FOR
HEALTHY BOYS AND GIRLS OF MEDIAN WEIGHT AND
HEIGHT
Age Boys EER (kcal/kg/day) Girls EER (kcal/kg/day)
0–2 mo 107 104
3 mo 95 95
4–35 mo 82 82

8. Median
Weight, Boys
(kg)
sedentary[†]
(kcal/kg/d)
Active[†]
(kcal/kg/d)
Median
Weight, Girls
(kg)
Sedentary[†]
(kcal/kg/d)
Active[†]
(kcal/kg/d)
3 yr 14.3 80 104 13.9 76 100
4 yr 16.2 74 97 15.8 70 93
5 yr 18.4 68 90 17.9 65 87
6 yr 20.7 63 84 20.2 61 81
7 yr 23.1 59 80 22.8 56 75
8 yr 25.6 56 75 25.6 52 71
9 yr 28.6 53 71 29.0 48 65
10 yr 31.9 49 67 32.9 44 60
11 yr 35.9 46 63 37.2 41 56
12 yr 40.5 44 60 41.6 38 52
13 yr 45.6 42 57 45.8 36 50
14 yr 51.0 40 55 49.4 34 47
15 yr 56.3 39 54 52.0 33 45
16 yr 60.9 38 52 53.9 32 44
17 yr 64.6 36 50 55.1 31 43
18 yr 67.2 35 49 56.2 30 42

9. Fluid Calculation
• Fluid requirement of a 2 year old child by
various methods
• 2 year old child has
Weight 50th centile= 12 kg
Height 50th Centile = 86 cm
BSA=0.534 m sq
Caloric Requirement- 82kcal/kg

10. Fluid Calculation
• Caloric method.
Total calorie requirement for 24 hrs- 82 x12=
984 kcal
For each 100kcal requires 100-120ml water
So 984 Kcal requires-120 x 9.84=1180 ml/24 hrs
Electrolyte requirement.
Na- 4 x 9.84 =39 Meq/24 hrs
K- 3 x 9.84 = 29 meq/24hrs

11. Fluid Calculation
• HOLLIDAY-SEGAR METHOD
For a child with 12 kg weight will require 1100 ml of
fluid/24 hrs
-for first 10 kg require 100ml/kg which is
10 x100 =1000 ml.
For next 2 kg 50 ml/kg which is 2 x 50 =100
Total Fluid Requirement =1100/24hrs
Electolytes Requirements-
Na-12 x 3= 36meq/24 hrs
K-12x 2=24meq/24hrs

12. Fluid Calculation
• BODY SURFACE AREA METHOD
Child with 12 kg and 86 cm
BSA= 0.534
For 1 m sq 1500ml/24 hrs
So he will require 0.534 x 1500= 801 ml/24 hrs
Electrolyte Requirement:
Na-0.534 x 50= 27 meq /24 hrs
K-0.534 x 40=21meq /24 hrs