Using the standard pediatric maintenance fluid formula (Holliday-Segar method), calculate the 24-hour maintenance fluid requirement for an 8-year-old child weighing 23 kg.

1. A

   1500 ml

2. B

   1560 ml

3. C

   . 1600 ml

4. D

   1650 ml

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The Holliday-Segar method is a weight-based formula used to calculate maintenance fluid requirements in children.
• For a 23 kg child, the calculation is broken into three tiers: the first 10 kg, the next 10 kg, and the remaining weight.
• First 10 kg: 10 kg × 100 mL/kg = 1000 mL.
• Next 10 kg (from 11 to 20 kg): 10 kg × 50 mL/kg = 500 mL.
• Remaining 3 kg (from 21 to 23 kg): 3 kg × 20 mL/kg = 60 mL.
• The total 24-hour fluid requirement is the sum of these amounts: 1000 + 500 + 60 = 1560 mL.

Why Other Options Were Wrong

• Option A: This value (1500 mL) represents the maintenance fluid requirement for a child weighing exactly 20 kg (1000 mL for the first 10 kg + 500 mL for the next 10 kg). It fails to account for the additional 3 kg of the child's weight.
• Option C: This is an incorrect calculation. It does not align with any logical application or common misapplication of the Holliday-Segar formula tiers. It is likely a simple arithmetic error.
• Option D: This value results from a common calculation error where the fluid rate for the second tier (50 mL/kg) is incorrectly applied to the final weight tier. The calculation would be 1500 mL + (3 kg × 50 mL/kg) = 1650 mL. The correct rate for weight above 20 kg is 20 mL/kg.

Related Visual

• Visual 1: Infographic: A visual guide to the Holliday-Segar formula, showing the different fluid rates for each weight bracket (0-10 kg, 11-20 kg, >20 kg) and a sample calculation.
• Visual 2: Flowchart: A step-by-step flowchart for calculating pediatric maintenance fluids, starting with weighing the child and following the branches for each tier of the Holliday-Segar method.

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 method as background academic context rather than a clinical decision trigger.
• Accurate maintenance fluid calculation is a fundamental nursing skill in pediatrics to prevent iatrogenic dehydration or fluid overload, both of which can have severe consequences like electrolyte imbalances and cerebral edema.
• Nurses must continuously monitor pediatric patients on IV fluids for signs of fluid imbalance, including urine output, daily weights, skin turgor, and vital signs, and adjust therapy as ordered.
• What if the child had a persistent fever of 39°C? Fluid needs would increase. For each degree Celsius above 38°C, maintenance fluid requirements increase by approximately 10-15%. The nurse would anticipate an order to increase the IV fluid rate accordingly.

How to Approach the Question

• First, identify the key information provided: the child's weight (23 kg) and the method to be used (Holliday-Segar).
• Recall or look up the three tiers of the Holliday-Segar formula: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for the remainder.
• Break down the child's weight into these tiers: 23 kg = 10 kg + 10 kg + 3 kg.
• Calculate the fluid for each tier separately: (10 × 100) + (10 × 50) + (3 × 20).
• Sum the results from each tier to find the total 24-hour fluid requirement.
• Compare your final calculated value with the given options to select the correct answer.

Concept Tested & Keywords

• Concept Tested: Pediatric maintenance fluid calculation using the Holliday-Segar method.
• Stem keywords: pediatric maintenance fluid, Holliday-Segar method, calculate, 23 kg
• Lead-in keywords: calculate
• Clinical cues: 8-year-old child
• Clinical cues: weighing 23 kg

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