Fluids and burns
Maintenance fluids (Holliday–Segar)
Daily and hourly maintenance fluid volumes from weight, as used by NICE.
For education. Check against your unit's guidance and a second clinician before use.
Not for newborns in the first 4 weeks of life, who have separate NICE guidance.
kg
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Before you use this
- NICE advises isotonic fluids with sodium 131–154 mmol/L for routine maintenance, with glucose as needed.
- Many PICU patients need less. NICE suggests restricting to 50–80% of full maintenance if there is a risk of fluid retention (for example raised intracranial pressure, lung disease, heart failure, kidney failure, or after surgery).
- Count all fluid given, including drugs, flushes and feeds, and check electrolytes and weight regularly.
How this is calculated
- 100 mL/kg/day for the first 10 kg
- plus 50 mL/kg/day for each kg from 10 to 20 kg
- plus 20 mL/kg/day for each kg over 20 kg
- Hourly rate = daily volume ÷ 24. (The "4-2-1" rule gives a very similar hourly rate.)
Sources
- NICE guideline NG29. Intravenous fluid therapy in children and young people in hospital (2015, updated 2020).
- Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823–32.
Checked by PICUlearn, 21 Sept 2026.