The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Accounting for deficits when determining the fluid. Maintenance fluid therapy as defined by Holliday and The formula assumes normal renal function . Holliday/Segar formula of ml/kg body weight (BW). The Maintenance Fluid Calculation for Children helps to determine the daily volume of fluids needed based on the weight of a child. This calculation also.
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The Holliday-Segar Method for calculating Maintenance Fluids and Electrolytes
First, the higher metabolic rate of children requires a greater caloric expenditure, which translates into higher fluid requirements. Patients with hypotonic or isotonic dehydration are given fluids using the same technique to calculate fluid amount and rate Table 5.
When monitoring patients ssgar are being treated with maintenance and deficit fluids for dehydration, the most important monitoring parameters are those which defined the dehydration in the first place, such as skin turgor, urine output, and thirst see Table 4 for a complete list. Clinical signs of dehydration should be taken into consideration first, as they can provide useful insight into the fluid needs of the patient. The degree of dehydration calculated should always be compared to the clinical signs, which may be better indicators of zegar status and are also especially useful when a pre-illness weight is unknown.
For the most part, practitioners can choose from commercially available products to adequately fulfill maintenance hollieay. It helps to estimate the fluid requirement in 24 hours. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy.
Thanks Nurse Hassan Like Like. There are many mechanisms of determining the maintenance fluid requirements for children.
Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy. Sear changes that take place as a child grows have a great effect on fluid requirements, making special attention to fluid therapy essential in pediatric pharmacotherapy. The most commonly used technique to calculate maintenance fluids for children is the Holliday-Segar method Table 2.
The Holliday-Segar Method
Generally speaking, the oral route for providing fluid therapy is preferred as soon as it is clinically indicated, as any intravenous administration brings with it the risk of infection. Replacement fluids are defined as those given to meet ongoing losses due to medical treatment. T he commonly used method for approximating water loss and therefore the water requirement is the Holliday-Segar nomogram: Relation of electrolyte disturbances to cardiac arrhythmias.
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Calculate the maintenance water required for 30 kg child? The interval between doses is longer in premature infants, up to 48 hours, but this is associated with the immaturity of the neonatal kidney, and not total body water.
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Fluid therapy can sevar have an impact on drug therapy. For example, if a parenteral antibiotic is being mixed in mL and given four times per day, this could provide a significant amount of fluid to the patient.
By the time a patient is out of the neonatal period, the usual dose of gentamicin is 2. In phase I, a bolus of fluid is given in order to restore blood volume to ensure adequate perfusion of critical organs, such as the brain. Open in a separate window. Monitoring fluid and electrolyte therapy is an important role of the pediatric pharmacist.
The deficit fluid volume should be added to the maintenance fluid volume needed for 48 hours, and the holljday should be administered over 48 hours. Ensuring that the patient is not getting an excessive amount of fluids in medications can help prevent overhydration. Holluday of these examples demonstrates a situation where there is an ongoing loss which would not be met by administering only maintenance fluids. Young TE, Mangum B, editors.
Maintenance Fluid Requirements Quickchecks. Every 1 kg of weight lost is equivalent to 1 L of fluid loss. Caloric expenditure, and therefore the water requirement, for the hospitalized patient hollidya be estimated from the nomogram shown below. When considering fluid requirements in hospitalized children, potential increased or decreased needs should always be kept in mind. A formulq weighing 14kg was rushed to the emergency department.
This is generally given over a few hours, with serum sodium checks done throughout in order to avoid hypernatremia. These medications include insulin and beta adrenergic agonists such as albuterol. Monitoring serum electrolytes is necessary if the patient has electrolyte abnormalities, but when examining hydration, the most important indices to watch are the clinical parameters mentioned earlier. Hydration status can have an important impact on drug therapy, and should be considered when using medications with large volumes of distribution.
Footnotes Data from Rusconi F, et al.
Maintenance Fluid Requirements
Holliday and Segar collated information from a number of studies, hoolliday their own, and concluded the following:. In addition to total body water differences, the percent of body weight accounted for by intracellular and extracellular water nolliday changes.
Replacement Fluids Replacement fluids are defined as those given to meet ongoing losses due to medical treatment. Electrolyte replacement in intravenous fluids degar includes sodium, potassium, and chloride.
Patients who are not allowed anything by mouth for a short time, such as for an uncomplicated surgery, and for whom only maintenance fluids are required, may have their fluids decreased and eventually stopped once they tolerate oral hydration. The maintenance need for water in parenteral fluid therapy. In addition, children, especially infants, have higher respiratory rates, 8 and this equates to higher insensible losses from the respiratory tract Table 1.