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 standard weight-based formula used to calculate daily maintenance fluid requirements in children.
• The formula divides the child's weight into three tiers, applying a different fluid rate to each part.
• For a 23 kg child, the first 10 kg requires 1000 mL (10 kg × 100 mL/kg).
• The next 10 kg (from 11 to 20 kg) requires 500 mL (10 kg × 50 mL/kg).
• The remaining 3 kg (from 21 to 23 kg) requires 60 mL (3 kg × 20 mL/kg).
• Summing these amounts (1000 + 500 + 60) gives a total 24-hour fluid requirement of 1560 mL.

Why Other Options Were Wrong

• Option A: This value represents the maintenance fluid requirement for a 20 kg child (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 result is a calculation error. It might occur if the fluid for the final weight segment was miscalculated, for instance, by incorrectly rounding up the weight or using an incorrect rate.
• Option D: This is an incorrect calculation. It could result from applying the wrong rate to one of the weight tiers, such as using 50 mL/kg instead of 20 mL/kg for the final 3 kg (1500 mL + 3 kg x 50 mL/kg = 1650 mL).

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Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Calculation of pediatric maintenance fluids using the Holliday-Segar method as background academic context rather than a clinical decision trigger.
• Proficiency in calculating maintenance fluids is a fundamental nursing skill in pediatrics to ensure patient safety.
• Children are at a higher risk for fluid imbalances due to their unique physiology; thus, precise fluid management is essential to prevent complications like dehydration, fluid overload, and electrolyte disturbances.
• What if the child had a persistent fever of 39°C? The maintenance fluid rate would need to be increased. A common guideline is to increase fluids by 10-15% for each degree Celsius above 38°C to compensate for increased insensible water loss.

How to Approach the Question

• First, identify that the question is a calculation problem requiring a specific formula (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 remaining weight.
• Break down the child's weight (23 kg) according to these tiers: 10 kg, 10 kg, and 3 kg.
• Systematically calculate the fluid volume for each tier.
• Sum the volumes from all three tiers to get the total 24-hour maintenance fluid requirement.
• Finally, match your calculated result to the provided options.

Concept Tested & Keywords

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

Question ID

QaZzINyy1b16J8NE-cTs7e

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 571-573

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 55-57