Maintenance Fluid Therapy in Children

Introduction to Maintenance Fluids

• Maintenance fluid should be provided at 80-120 mL/kg/day using an isotonic solution (Na 140 mmol/L) to reduce the risk of hospital-acquired hyponatremia in children, as recommended by Clinical Nutrition guidelines 1
• The Holliday-Segar formula is the standard method for calculating maintenance fluid requirements in children, recommending 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 25 mL/kg/day for each additional kg above 20 kg 1

Solution Type and Electrolyte Content

• Isotonic solution (Na 140 mmol/L) is strongly recommended over traditional hypotonic solutions for maintenance IV fluids in hospitalized children, as suggested by Clinical Nutrition and Intensive Care Medicine guidelines 1, 2, 3
• The recommended daily electrolyte content is: Sodium (1-3 mmol/kg/day), Potassium (1-3 mmol/kg/day), and Chloride (2-4 mmol/kg/day), according to Clinical Nutrition guidelines 1

Adjusting Fluid Requirements

• Fluid requirements must be adjusted based on the child's clinical condition, with:

Risks and Complications

• Using hypotonic fluids increases the risk of hyponatremia and potentially fatal hyponatremic encephalopathy, as warned by Clinical Nutrition and Intensive Care Medicine guidelines 1, 2
• Isotonic balanced solutions are preferred to reduce the risk of hospital-acquired hyponatremia and hyponatremic encephalopathy, according to Intensive Care Medicine guidelines 2

Monitoring and Administration

• Regular monitoring is essential when administering maintenance fluids, including:
• Potential pitfalls include using hypotonic fluids, failure to account for "fluid creep", not adjusting fluid rates in children with conditions affecting fluid balance, and overlooking the need for glucose in maintenance fluids, as warned by Clinical Nutrition and Intensive Care Medicine guidelines 1, 2