A child having 18 kg weight is admitted with dehydration. What is the intravenous fluid requirement for 24 ho… - KPSC Staff Nurse - 2021

KPSC Staff Nurse - 2021

Child Health Nursing (Pediatrics)

Hard

Appeared in: KPSC Staff Nurse - 2021

Explanation

The standard method for calculating daily maintenance IV fluids in children is the Holliday-Segar formula, also known as the 100/50/20 rule.
For an 18 kg child, the calculation is performed in two tiers based on weight.
The first 10 kg of body weight requires 100 mL/kg, which totals 1000 mL (10 kg × 100 mL/kg).
The subsequent 8 kg of weight (from 11 kg to 18 kg) falls into the second tier, requiring 50 mL/kg, which totals 400 mL (8 kg × 50 mL/kg).
The total 24-hour maintenance fluid requirement is the sum of these amounts: 1000 mL + 400 mL = 1400 mL.

Option A: This value is too low and does not correspond to the correct application of the Holliday-Segar formula. It may result from a significant miscalculation, such as using incorrect multipliers for the weight tiers.
Option C: This value is too high. It may be the result of an arithmetic error, such as incorrectly calculating the fluid for the second weight tier or adding the components incorrectly.
Option D: This value is significantly too high for maintenance needs. It might be obtained by incorrectly applying a single rule, like 100 mL/kg, to the entire body weight and then rounding up (18 kg x 100 mL/kg = 1800 mL).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pediatric maintenance fluid calculation using the Holliday-Segar formula as background academic context rather than a clinical decision trigger.
The Holliday-Segar formula calculates maintenance fluids, which cover basal metabolic needs. It does not account for fluid deficits from dehydration.
In a dehydrated child, total fluid therapy involves three components: deficit replacement, maintenance fluids, and replacement of ongoing losses (e.g., from diarrhea or vomiting).
Nurses must monitor the child's response to fluid therapy closely, including urine output (aiming for greater than 1 mL/kg/hr), daily weight, and clinical signs of hydration.

How to Approach the Question

Identify that the question asks for a 24-hour fluid calculation for a child with a specific weight.
Recall the standard formula for pediatric maintenance fluids, which is the Holliday-Segar (or 100/50/20) rule.
Break down the child's weight (18 kg) according to the formula's tiers.
Calculate the fluid for the first 10 kg: 10 kg × 100 mL/kg = 1000 mL.
Calculate the fluid for the weight in the next tier (11-20 kg): (18 - 10) kg × 50 mL/kg = 8 kg × 50 mL/kg = 400 mL.
Sum the amounts to find the total daily maintenance fluid: 1000 mL + 400 mL = 1400 mL.

Concept Tested & Keywords

Concept Tested: Pediatric maintenance fluid calculation using the Holliday-Segar formula.
Stem keywords: child, 18 kg weight, dehydration, intravenous fluid requirement, 24 hours
Lead-in keywords: What is
Clinical cues: Patient is a child weighing 18 kg, which is a key parameter for pediatric calculations.
Clinical cues: The term 'dehydration' indicates a fluid volume deficit, but the question likely tests for maintenance fluid calculation as a baseline.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 56-58, 312-314