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4kg pt need 400 ml / day  according to holiday segar method

Why according to picu protocol EHA ot take 325 ml/day 

Hossam Elgnainy Selected answer as best April 11, 2025
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Update:

Please be advised that after a second review, we found that the table is generally correct in the sense of final rate. Despite that, the table numbers are generally inconsistent. The following table may be more accurate in sense of numbers.

Hossam Elgnainy Posted new comment April 11, 2025
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Ref. Of table please dr. Hossam

This table is made by our team on Excel using the usual formula of holliday segar method
100ml/kg for first 10kg of patient wt
1000ml + 50ml/kg for wt above 10kg
1500ml + 20ml/kg for wt above 20kg
and the deficit formula
1% dehydration = 10 mL/kg of fluid deficit
and following the same criteria of ISPAD 2018 that assumed the deficit will be calculated on 5% disregarding the severity of dehydration in the table.

The original table in the question is mentioned in the ISPAD 2018 and removed from ISPAD 2022

We still recommend against using the table, even after that correction. We just made that table to prove the idea that the original table was not accurate.

We recommend to follow the recent guidelines of ISPAD 2022

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Apparently they substracted the initial bolus “shock therapy” volume from the maintenance. 

If we go to the header of the table, then for a patient weights 4 kg:

If the bolus is 20ml/kg= 80ml

and the total maintenance is 400ml

Then the maintenance in that table should be 320ml not 325ml

And for the next column “maintenance + 5% of weight”

Then it will be either

320+5%(16)=336 ml

14ml/h

Or

400+5%(20)=420 ml

17.5ml/hr

So I assume they mean 50% not 5%

and even by that table standard

325+50%(162.5)=487.5 ml Not 530

So my professional advice for you, don’t take that guide as trusted source. If you trace it down, you will find it full of mistakes like this.

I advice you to follow a trusted guide like the following wehen treating DKA.

Wolfsdorf J. Glaser N. Sperling MA; American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association, Diabetes Care. 2006 May: 29(5):1150-9

Glaser N. Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes, 2022 Nov;23(7):835-856

Hossam Elgnainy Changed status to publish April 11, 2025