Paediatrics
Paediatric maintenance fluid calculator (Holliday–Segar)
Calculate paediatric maintenance fluid volume using the Holliday–Segar method, with the 4-2-1 hourly rate. For use by licensed clinicians.
Maintenance requirement
44mL/hour
Equivalent to approximately 1100 mL over 24 hours. Maintenance only — deficit replacement and ongoing losses are calculated separately and added. Isotonic fluid is generally preferred for maintenance in hospitalised children; follow your local protocol.
For use by licensed clinicians as a calculation aid only. It does not account for the individual patient context, and it does not replace clinical judgement or your local protocol. Verify any value before it informs a dose or a decision.
Equation used
Daily: 100 mL/kg for the first 10 kg + 50 mL/kg for the next 10 kg + 20 mL/kg for each kg above 20. Hourly (4-2-1): 4 mL/kg/h for the first 10 kg + 2 mL/kg/h for the next 10 kg + 1 mL/kg/h thereafter.
Source
Holliday MA, Segar WE, Pediatrics, 1957
Maintenance requirement only. It does not account for existing deficit, ongoing losses, or conditions requiring fluid restriction.
Common questions
Does this include a fluid deficit or ongoing losses?
No. Holliday–Segar gives the maintenance requirement only. Deficit replacement and ongoing losses are calculated separately and added.
Which fluid should be used for maintenance in children?
Isotonic fluid is now generally preferred over hypotonic fluid for maintenance in most hospitalised children because of the hyponatraemia risk. Follow your local paediatric protocol.