Pediatric Maintenance Fluids Requirement Calculator (Holliday-Segar method)

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The Holliday-Segar nomogram offers an estimation of daily fluid loss and consequent fluid requirements with the following guidelines:

• 100 ml per kilogram for the first 10 kilograms of weight.
• 50 ml per kilogram for the next 10 kilograms of weight.
• 20 ml per kilogram for the remaining weight.

Although the consideration of fluid needs is typically done on a 24-hour basis, hospital infusion pumps are designed for hourly programming. Therefore, the 24-hour total is often divided into approximate hourly rates for practicality, giving rise to the “4-2-1” formula:

• 100 ml/kg/24-hours translates to 4 ml/kg/hr for the initial 10 kilograms.
• 50 ml/kg/24-hours corresponds to 2 ml/kg/hr for the subsequent 10 kilograms.
• 20 ml/kg/24-hours equates to 1 ml/kg/hr for the remaining weight.

In most practical cases, especially in critical care settings, calculating the the total daily fluids is of great usefulness.