Calculating Daily Maintenance Fluid Requirements (Nursing)

00:01 Calculating daily maintenance fluid requirements can look a little complicated.

00:05 But we're going to break it down for you.

00:09 So when you need to administer IV fluids to a pediatric patient.

00:12 You need to have a way to make sure that you're administering the correct amount of IV fluids.

00:17 Here is an IV fluid calculation formula that can help you determine the maintenance rate for your pediatric patient.

00:24 For the first 10 kilograms of weight for your patient, you're going to administer 100 milliliters per kilo of fluid.

00:34 For the second 10 kilos of weight for your pediatric patient, we're going to add in 50 milliliters per kilo of fluid.

00:43 For anything over 20 kilos, for each additional kilo, we're going to add in 20 milliliters per kilo of fluid.

00:52 Now, don't worry if this seems a little weird.

00:54 We're going to help it make sense for you.

00:57 So, now we're going to practice.

00:59 And we are going to find the daily and hourly maintenance fluid rate for the child who weighs 11 kilos.

01:07 For the first 10 kilos, you're going to have 100 milliliters x 10 kilos.

01:13 If you remember your formula.

01:15 So that's going to give you 1000 milliliters of fluid.

01:19 Then you have one additional kilo to factor in because this child weighs 11 kilos.

01:25 So 50 milliliters x that one kilo gives you an additional 50 milliliters of fluid.

01:31 And then you don't have to worry about the third part of the formula because this child does not weigh over 20 kilos.

01:38 So what that looks like if you write it out on paper is you have that first 1000 milliliters for the first 10 kilos.

01:44 And then you have an additional 50 milliliters.

01:47 So that's going to give you 1,050 milliliters over the course of a day.

01:52 So for 24 hours, they're going to get a total of 1,050 milliliters.

01:58 When you break that down, that comes to 44 milliliters per hour.

02:04 We're going to continue with our calculations practice.

02:07 And when we think about the second example, we're going to think about what adjustments you might need to make to your maintenance fluid therapy.

02:16 Sometimes we need to make adjustments if patients are experiencing ongoing losses.

02:21 For example, if they're vomiting, or if they're having diarrhea, or maybe they're just having poor intake.

02:26 We might need to adjust the initial calculations that we came up with.

02:31 For every shift part of what a nurse is going to pay attention to is that total fluid intake and output.

02:37 And when we do that, we're going to notice if there's a fluid volume deficit.

02:42 If that deficit is noticed, then there are a couple of ways that we can overcome that deficit.

02:48 We might order some additional PO fluids, if the patient is tolerating taking things by mouth.

02:54 We might just increase the maintenance rate.

02:57 It might be it one and a quarter times maintenance all the way up to maybe even double the maintenance rate.

03:03 Or we may decide that we're going to give them an IV bolus.

03:10 So, to compensate for ongoing dehydration, we'll practice again.

03:16 The physician asks you to make the patient's IV maintenance fluids run at 1.5x the normal rate.

03:23 That means that we need to find the daily and hourly maintenance rate.

03:27 And we're going to use the example of a patient that weighs 32 kilos.

03:31 Now, that's a big pediatric patient.

03:34 Then, we're going to find the hourly rate that we are going to use and increase that to 1.5 times that rate.

03:43 So what's that going to look like? So again, that first 10 kilos with the 100 milliliters times that first 10 kilos is going to give you 1,000 milliliters.

03:54 In this instance, we have 50 milliliters x 10 kilos because our patient weighs over 20 kilos.

04:01 So that's going to be 500 milliliters in that second step.

04:05 And then the third step for every kilo that's over 20 kilos, which in this case is 12.

04:13 We're going to add an additional 20 milliliters per kilo.

04:17 So that equals 240 milliliters.

04:20 When you put that together, you have the 1000, plus the 500, plus the 240.

04:27 And that gives you 1,740 milliliters per day.

04:31 When you divide that out by 24 hours, that gives you 72.5 milliliters per hour.

04:38 And yes, in the pediatric world, sometimes you are going to run the IV fluids at 72.5 instead of rounding up.

04:47 That can be a little bit of a difference from the adult world.

04:52 So there's a little bit of a calculations tip here.

04:55 If you have a patient that is over 20 kilos, you know automatically that the first and second step is going to equal up to 1,500 milliliters.

05:08 So you don't necessarily have to do the math every time if your patient weighs over 20 kilos.

05:16 Now, we're going to find the hourly rate to account for an increase in that 32 kilo patient that needed some replacement of fluid losses.

05:28 And the provider wants you to increase that to 1.5 times maintenance.

05:33 What's that going to look like? So we had 1,740 milliliters that we found as the daily requirement for our 32 kilo patient.

05:42 And we're just going to time multiply that by 1.5.

05:47 That's going to give you 2,610 milliliters per day.

05:51 And you're going to divide that out by 24 hours, which gives you 108 milliliters per hour.

05:57 So it's not that hard.

06:01 There is a bit of a different way to think about this.

06:04 If you want to kind of think about it in terms of hourly fluid requirements rather than daily fluid requirements.

06:12 And you will often hear reference to the 4-2-1 Rule.

06:17 So the 4-2-1 Rule can be also an easy way to calculate hourly fluid rates for pediatric patients.

06:24 For patients that are less than 10 kilos, they're going to get 4 milliliters per kilo.

06:31 So whatever their weight is, you times that by 4 milliliters, that's your hourly rate.

06:37 For a patient that is 10 to 20 kilos, you do 4 milliliters per kilo per hour for the first 10 kilos, and then it's 2 milliliters per kilo for the next 10 kilos.

06:53 If your patient weighs more than 20 kilos, you're going to take every kilo over 20 and multiply that by one milliliter and you're going to add that to the two previous calculations.

07:05 So we have walked through how to calculate the daily and hourly maintenance fluid rates for a child.

07:10 And how to adjust that rate to account for additional fluid losses.

07:15 Remember, as the nurse, it is your responsibility to calculate and ensure the rate of fluid replacement is safe for the client.