نظرة سريرية عامة

Maintenance fluid estimation is a structured clinical decision-support tool. It approximates basal water needs from weight using daily Holliday-Segar and hourly 4-2-1 conventions. It standardizes calculation and communication, but its output remains an estimate that must be interpreted with the complete history, examination, laboratory method, imaging, serial trend, and institutional protocol. Enter contemporaneous data and verify units before relying on the result.

The displayed category reflects cohorts and conventional thresholds rather than a diagnosis or mandatory treatment instruction. Document inputs with the result, reassess when the patient changes, and prioritize time-critical stabilization over score completion. Discordance between the calculated estimate and clinical concern should prompt review of measurements, assumptions, competing diagnoses, and specialist advice.

دواعي الاستخدام

• Initial maintenance-water estimate when enteral intake is unavailable
• Hourly and daily cross-check by body weight

القيود والسلامة

These are not interchangeable exact conversions and do not include deficits, resuscitation, or ongoing abnormal losses. Performance varies with population, prevalence, disease stage, treatment era, and local laboratory reference intervals. Avoid extrapolation to groups excluded from validation, and do not use a low score to dismiss concerning symptoms or a high score to prove a diagnosis.

Clinical decisions should incorporate contraindications, comorbidities, patient preferences, and current regional guidance. Pregnancy, childhood, older age, critical illness, altered physiology, and organ failure often require population-specific interpretation. Clinipocket stores no entered patient values; record clinically relevant results in the approved medical record.

• Not a resuscitation or replacement-fluid formula
• Renal, cardiac, hepatic failure, neonates, fever, burns, and critical illness require adjustment

المعادلة

Daily: first 10 kg ×100 mL + next 10 kg ×50 + each kg >20 ×20. Hourly 4-2-1: first 10 kg ×4 + next 10 ×2 + each kg >20 ×1

تفسير النتائج

• First 10 kg — 100 mL/kg/day; 4 mL/kg/h: Highest weight-based segment. Add only the applicable segment.
• Second 10 kg — 50 mL/kg/day; 2 mL/kg/h: Applied from 10–20 kg. Add to first segment.
• Each kg >20 — 20 mL/kg/day; 1 mL/kg/h: Applied above 20 kg. Add and then individualize.

المراجع

1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy.
2. AAP Clinical Practice Guideline: Maintenance Intravenous Fluids in Children.

الأسئلة الشائعة

Is this for fluid boluses?

No. Resuscitation boluses and replacement of losses are separate.

Why do daily and hourly answers differ?

The 4-2-1 shortcut is not exactly daily Holliday-Segar divided by 24.

Should hypotonic fluid be used in children?

Fluid composition follows current pediatric guidance and clinical context; many hospitalized children receive isotonic maintenance fluid with appropriate dextrose and potassium considerations.