This is something that was taught in my surgical rotation, I remember the vascular surgeon complaining that this is probably one of the most overlooked items in the ED. When we order IV fluids, how much thought do we really put in?
Odds are rate is set at 100mL/hr, it's easy to remember and simple to input to a pump. Is that enough?
Here's a refresher, remember 4-2-1:
From 0-10kg, it's 4ml/kg/hr
10-20lg, add 2ml/kg/hr
> 20kg, add 1ml/kg/hr
Great, you got it memorized!...What does it mean?
170lb gentleman comes in the ED:
170lb/2.2= 77kg.
First, let's break down the 77kg= 10 + 10 + 57.
Thus, for the 1st 10kg, they get 40mL.
The next 10kg they get 20mL, and the remainder is 57mL.
40mL + 20mL + 57mL = 117mL/hr
Pediatric bolus: 20mL/kg!
How about those cute little kids?
It's the same formula x 1.5.
So let's say we have a 170lb kiddo (big boy!) the rate is 117mL/hr x 1.5= 176mL/hr
There's the quick and dirty.
Don't forget, it's also in the back side of the orange page in Maxwell!!!!
There's always mdcalc for a quick reference and calculation:
References:
Somer, MJ. Maintenance fluid therapy in children. In: UpToDate, Basow, DS (Ed), UpToDate,Waltham, MA, 2012.
Maxwell, R.W. (2006). Maxwell Quick Medical Reference (5th ed.). Maxwell Publishing, Minneapolis, MN.
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