[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Maintenance fluid volume in children (Holliday–Segar), worked examples # Maintenance fluid volume in children (Holliday–Segar), worked examples - Calculation The Holliday–Segar rule estimates a child's daily or hourly maintenance fluid from body weight in three bands; the prescriber sets the actual order. Updated Nov 13, 2026 ## Key points - Educational example, not a clinical order. - Daily rule: 100 mL/kg for each of the first 10 kg, plus 50 mL/kg for each of the next 10 kg, plus 20 mL/kg for each kg above 20. - Hourly rule (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 for each kg above 20. - Use the current weight in kilograms, and work band by band: never multiply the whole weight by one band. - Isotonic fluids caused less hospital-acquired hyponatraemia than hypotonic fluids in trials. ## What it is Maintenance fluid replaces the water a child uses each day. The Holliday–Segar method, published in 1957, estimates it from weight in three bands, and it is still used by current guidelines. The nurse uses the formula to understand and double-check an order, not to decide it: the prescriber chooses the fluid, which current guidance says should usually be isotonic, and may order a percentage of the calculated volume. This page gives the formula and worked examples on made-up children, each calculated both ways (daily and hourly). ## Formulas - Daily volume = (first 10 kg × 100 mL/kg) + (next 10 kg × 50 mL/kg) + (each kg above 20 × 20 mL/kg). - Hourly rate = (first 10 kg × 4 mL/kg/h) + (next 10 kg × 2 mL/kg/h) + (each kg above 20 × 1 mL/kg/h). - Hourly rate from a daily volume = daily volume ÷ 24. - Ordered rate = calculated maintenance × the percentage the prescriber ordered. - The 4-2-1 hourly rule is a rounded form of the daily rule (100 ÷ 24 ≈ 4.2), so the hourly rate × 24 comes out slightly below the daily total; a gap of 1–2 mL/h is expected. ## How to calculate it - Take the child's current weight in kilograms from the chart. - Split the weight into bands: up to 10 kg, the part between 10 and 20 kg, and the part above 20 kg. - Multiply each band by its own factor (daily or hourly rule) and add the results. - If the order is a percentage of maintenance, multiply the result by that percentage. - Convert to the pump rate (per hour) or drip rate as the drip-rate page shows. - Compare your result with the order; if they differ, stop and ask before starting. ## Worked examples | Example (invented child) | Daily total (100-50-20) | Hourly rate (4-2-1) | Check: do the two agree? | | --- | --- | --- | --- | | 1. Infant, 7 kg | 7 × 100 = 700 mL/day | 7 × 4 = 28 mL/h | 700 ÷ 24 ≈ 29.2 mL/h; 28 × 24 = 672 mL/day: they agree within about 1 mL/h | | 2. Child, 15 kg | (10 × 100) + (5 × 50) = 1000 + 250 = 1250 mL/day | (10 × 4) + (5 × 2) = 40 + 10 = 50 mL/h | 1250 ÷ 24 ≈ 52.1 mL/h; 50 × 24 = 1200 mL/day: they agree within about 2 mL/h | | 3. Child, 24 kg | (10 × 100) + (10 × 50) + (4 × 20) = 1000 + 500 + 80 = 1580 mL/day | (10 × 4) + (10 × 2) + (4 × 1) = 40 + 20 + 4 = 64 mL/h | 1580 ÷ 24 ≈ 65.8 mL/h; 64 × 24 = 1536 mL/day: they agree within about 2 mL/h | | 4. Child, 32 kg | (10 × 100) + (10 × 50) + (12 × 20) = 1000 + 500 + 240 = 1740 mL/day | (10 × 4) + (10 × 2) + (12 × 1) = 40 + 20 + 12 = 72 mL/h | 1740 ÷ 24 = 72.5 mL/h; 72 × 24 = 1728 mL/day: they agree within 1 mL/h | ## Common mistakes - Multiplying the whole weight by the first band's factor, which overestimates the volume. - Using an old or estimated weight. - Forgetting the percentage the prescriber ordered. - Starting the infusion before the order and your calculation agree. ## Double-checking - Educational content only, not an order for a real patient. Volumes are set by the treating team per local guidance. - Recalculate independently and compare with the order and the pump programme. - Check the pump settings against the order at every handover. - While the infusion runs, check vital signs and the IV site, and watch for vomiting, headache, altered consciousness or signs of overload; report them. - Record intake and output and weigh the child as the protocol says; sodium is checked by laboratory as ordered. ## Test yourself Think of the answer, then tap the question to see it. ## What are the three daily factors of the Holliday–Segar rule? 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg and 20 mL/kg for each kg above 20. ## What is the hourly version of the rule called, and what are its factors? The 4-2-1 rule: 4, 2 and 1 mL/kg/h for the three weight bands. ## Who decides the type and percentage of maintenance fluid? The prescriber; the nurse uses the formula to check the order. ## Which symptoms during maintenance fluids may signal low sodium? Vomiting, headache and altered consciousness; they must be reported. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/maintenance-fluid-volume-in-children-worked-examples/) ## Elsewhere in DurgiPedia - [Dehydration and fluid overload](https://durgical.com/en/physiology/dehydration-and-fluid-overload/) ## Connections ## Related 3 - [IV flow rates: millilitres per hour and drops per minute](https://durgical.com/en/nursing/iv-flow-rates-millilitres-per-hour-and-drops-per-minute/) - [Peripheral IV therapy in children: sites, securement, pumps and fluid-overload risk](https://durgical.com/en/nursing/peripheral-iv-therapy-in-children-sites-securement-pumps-and-fluid-overload-risk/) - [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children (BMC Pediatrics 11:82)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3187723/) (BMC Pediatrics (open access, CC BY, PMC3187723), 2011); [Pediatric perioperative fluid management (Saudi Journal of Anaesthesia 15(4):435–440)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8477784/) (Saudi Journal of Anaesthesia (open access, PMC8477784), 2021); [Hypotonic and isotonic intravenous maintenance fluids in hospitalised paediatric patients: a randomised controlled trial (BMJ Paediatrics Open 3:e000385)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6542423/) (BMJ Paediatrics Open (open access, PMC6542423), 2019); [Nursing Skills, 23.3 Intravenous Therapy Assessment (Open RN, CC BY 4.0)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/23%3A_IV_Therapy_Management/23.03%3A_Intravenous_Therapy_Assessment) (Open Resources for Nursing (Open RN) / LibreTexts, 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/maintenance-fluid-volume-in-children-worked-examples/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/maintenance-fluid-volume-in-children-worked-examples/