Paediatric Maintenance Fluids (4-2-1)
Hourly and daily maintenance fluid for a child, by the Holliday-Segar method.
When to use it. Prescribing routine maintenance fluid for a child who is not dehydrated.
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Limits of this score. MAINTENANCE ONLY. Deficit and ongoing losses are added on top, and a shocked child needs a bolus first. Use an isotonic fluid with glucose — hypotonic maintenance fluid caused fatal hyponatraemia often enough that guidelines now forbid it. Recheck sodium within 24 hours.
Sources
- Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823–32.
- NICE NG29. Intravenous fluid therapy in children and young people in hospital. 2015.
Where this is written from. This site is written from Indian clinical practice. Drug availability and brand names, vaccination schedules, national health programmes and some reference cut-offs differ between countries — a schedule or a threshold that is standard here may not be standard where you are. If you are reading outside India, check anything on this page against your own country’s guidance before you act on it.
Educational use only — not medical advice. Never a substitute for clinical judgement.