Hi, this is Cathy with Level Up RN. In this video, I will explain how to calculate the amount of maintenance fluids required by a pediatric patient within a 24-hour period. You can find all the information that I'll be covering in this video in our Level Up RN dosage calculation workbook. If you are in nursing school, then you know how important it is to master dosage calculations, and our workbook will help you do just that. In a nutshell, our workbook contains all different types of dosage calculation problems that you are likely to encounter in nursing school. And we demonstrate how to solve each problem using multiple methods so you can pick the way that makes the most sense to you.
In order to calculate the child's fluid requirements, we can use something called the Holliday-Segar method. So with this method, it shows us how many milliliters to administer per day for a pediatric patient. So we want to provide 100 milliliters per kilogram per day for the first 10 kilograms of the patient's weight. We want to provide 50 milliliters per kilogram per day for the second 10 kilograms of the patient's weight. And then we want to provide 20 milliliters per kilogram per day for any remaining kilograms of the patient's weight. And then we would add up these three amounts, and that would give us the milliliters of fluid that we need to give the patient over the course of the day or 24 hours. Now, if our patient is severely dehydrated, our provider may order 1.5 or 2 times the maintenance fluids. If we are given an order like this, we would first calculate our maintenance fluids using this method, and then take that amount per day and multiply it times 1.5 or 2, depending on the provider's order. Okay. So we're going to work through an example problem so you can get comfortable and familiar with this type of calculation.
So in our example problem, we are being asked to calculate the maintenance fluids for a child who weighs 88 pounds, and we need to round our answers to the nearest hundredth. So right out of the gate, in order to use this method, we need to get our patient's weight to kilograms. So we would take 88 pounds, multiply times the conversion factor, right, which is basically, dividing by 2.2. And that would give us the patient's weight in kilograms. So our patient weighs 40 kilograms. Now we can answer the questions being asked. So how many milliliters of maintenance fluids does the child need in 24 hours? That's part A of the problem. So we would use this Holliday-Segar method. So for the first 10 kilograms of our patient's weight-- so our patient weighs 40 kilograms. But for the first 10 kilograms, I would give 100 milliliters per kilogram, so I would multiply that times 10 kilograms. And that means the patient needs 1,000 milliliters for that first 10 kilograms. For the second 10 kilograms, our patient would get 50 milliliters per kilogram. So I would take that, multiply times that second 10 kilograms, and I would get 500 mls. And then the remaining weight is 20 kilograms, right? So we have the remaining kilograms. Sorry, it's a little messy there. But basically, what we need to give is 20 milliliters per kilogram times that remaining amount of kilograms, which is 20 kilograms in our case. If our patient was 50 kilograms, then this would be 30, right? We would have 30 kilograms remaining. But our patient weighs 40, so we have 20 kilograms remaining. And if we calculate this out, we end up with 400 ml. So then we just take these three amounts, add them together, and that means our patient needs to get 1,900 milliliters per day, per 24-hour period. So that's the answer to Part A, how many milliliters of maintenance fluids does the child need in 24 hours.
Part B is, what would you set the pump at in milliliters per hour? So I would simply take this 1,900 milliliters, divide it by 24 hours to get the milliliters per hour. And if I do that calculation, I end up with 79.17 milliliters per hour. This is rounded to the nearest hundredth, which is what we were instructed to do here. And this is what I would set the pump at to deliver the maintenance fluids to the patient. Now, in part C, if the provider adjusts the order to include two times maintenance fluids, how many milliliters should be administered every 24 hours? So apparently, our patient is severely dehydrated. So for this, I would take their maintenance fluids which we already calculated, which is 1,900 milliliters per day, and I would multiply that times two to get their new amount of maintenance fluids, two times maintenance fluids. So that would be 3,800 milliliters per day that the patient would need to receive. And then part D is, what is the new IV pump setting in milliliters per hour? Again, I would just take the amount of milliliters that I need to give over the course of the day or 24 hours, divide by 24 hours to get the milliliters per hour, which is 158.33 milliliters per hour. And this is rounded to the nearest hundredth place, which is what we were instructed to do here. So this will be the new IV pump rate for two times the maintenance fluids.
