Updated by Piper Wenzel, BS April 2024

See also:

• Tonsillectomy and Adenoidectomy
• Maximum allowable blood loss

General Considerations

• Pediatric patients have weight-based minimum fluid intake requirements. In patients who have had tonsillectomies or other procedures affecting their ability to swallow, their daily fluid requirements should be calculated prior to discharge to determine if they will be able to stay adequately hydrated with PO intake once they are no longer receiving IV fluids.
• The Holliday-Segar Method provides a formula for calculating fluid requirements (Holliday-Segar 1957) - contemporary articles support continued use of this method with modifications based on overall health of the child with individualized rates of IV fluids "accounting for enteral fluid intake, IV medication fluids, and fluid loss (Alexander 2022) .
• Clinicians should be aware of clinical signs of dehydration and respond appropriately.

Signs of Dehydration

Table 1: Adapted from (Santillanes 2018, Alexander 2022, Cellucci 2023) 

Holliday-Segar Method

1. Daily fluid requirements (Holliday and Segar 1957)
   • 100 cc/kg for 1st 10 kg of the patient's weight
   • 50 cc/kg for the 2nd 10 kg of the patient's weight
   • 20 cc/kg for the remaining weight
2. Fluid requirements per hour: Daily fluid requirements are divided into approximate hourly rates which gives the "4-2-1" formula often used to calculate hourly infusion rates of IV fluids (Zieg 2024).
   • 100 cc/kg/24 hours= 4 cc/kg/hour for the 1st 10 kg of the patient's weight
   • 50 cc/kg/24 hours= 2 cc/kg/hour for the 2nd 10 kg of the patient's weight
   • 20 cc/kg/24 hours= 1 cc/kg/hour for the remaining weight
3. Example: A 35 kg child minimum hourly fluid intake would be: (4x10) + (2x10) + (1x15) = 75 cc/hour

Table 2: Quick reference for minimum fluid requirements (based on 4-2-1 formula above from Zieg 2024)

References

Flint et al. General Considerations in Pediatric Otolaryngology. Fluids and fluid management. Cummings Otolaryngology: Head and Neck Surgery, 5th ed. Chapter 180.

Holliday MA, Segar, WE. The maintenance need for water in parenteral fluid therapy. Journal of Pediatrics. 1957 (19) 823-832.

Alexander E, Weatherhead J, Creo A, Hanna C, Steien DB. Fluid management in hospitalized pediatric patients. Nutr Clin Pract. 2022 Oct;37(5):1033-1049. doi: 10.1002/ncp.10876. Epub 2022 Jun 24. PMID: 35748381.

Santillanes G, Rose E. Evaluation and Management of Dehydration in Children. Emerg Med Clin North Am. 2018 May;36(2):259-273. doi: 10.1016/j.emc.2017.12.004. Epub 2018 Feb 10. PMID: 29622321.

Zieg J, Narla D, Gonsorcikova L, Raina R. Fluid management in children with volume depletion. Pediatr Nephrol. 2024 Feb;39(2):423-434. doi: 10.1007/s00467-023-06080-z. Epub 2023 Jul 14. PMID: 37452205.

Cellucci MF. (2023, April). Dehydration in Children. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/dehydration-in-children