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Paediatric Maintenance Fluids (Holliday–Segar)

Maintenance fluid volume by the Holliday–Segar (100/50/20 or 4-2-1) method.

For healthcare professionalsChildren's healthv1.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

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Methodology

Holliday & Segar (1957); NICE NG29 (2015)

100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day thereafter; hourly rate by the 4-2-1 rule (4/2/1 mL/kg/h)

NICE NG29 uses the Holliday–Segar formula and recommends isotonic fluids; NICE advises restricting to 50–80% of routine maintenance when there is a risk of water retention from ADH secretion; the 2018 AAP guideline also recommends isotonic fluids. The 4-2-1 hourly rule is an approximation and can differ slightly from the daily volume ÷ 24.

Who it is for
Children over 28 days old (term neonates use different regimens).
Version
1.0.1

How this calculator works

Where the formula comes from

  • Holliday and Segar (1957) described the maintenance need for water in parenteral fluid therapy.[1]

What guidelines say

  • NICE NG29 (recommendation 1.4.1) calculates routine maintenance with Holliday–Segar: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg and 20 mL/kg/day above 20 kg; males rarely need more than 2,500 mL and females more than 2,000 mL a day.[2]
  • NICE advises initially using isotonic crystalloids (sodium 131–154 mmol/L) for routine maintenance, and restricting fluids to 50–80% of routine maintenance when there is a risk of water retention from non-osmotic ADH secretion.[2]
  • The 2018 AAP guideline strongly recommends isotonic maintenance fluids with appropriate potassium chloride and dextrose for patients aged 28 days to 18 years, because they significantly reduce the risk of hyponatraemia.[3]

Sources

  1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–832. doi:10.1542/peds.19.5.823
  2. National Institute for Health and Care Excellence. Intravenous fluid therapy in children and young people in hospital (NG29). London: NICE; 2015 (updated 2020). https://www.nice.org.uk/guidance/ng29/chapter/Recommendations
  3. Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate maintenance fluids (4-2-1)

Inputs

Weight
8 kg

Result

Approximate hourly rate (4-2-1 rule)
32 mL/h
Daily maintenance volume
800 mL/day

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Fluid type and volume are clinical decisions; this tool performs the arithmetic only.

References

  1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–832.
  2. Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083
  3. National Institute for Health and Care Excellence. Intravenous fluid therapy in children and young people in hospital (NG29). London: NICE; 2015 (updated 2020). https://www.nice.org.uk/guidance/ng29

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