Paediatric Maintenance Fluid Calculation — FRCA Final MCQ

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EasyPaediatric AnaesthesiaPaediatric Maintenance Fluid CalculationFRCA Final

A healthy 3-year-old child (15 kg) is undergoing elective inguinal hernia repair. The calculated maintenance IV fluid rate using the Holliday-Segar formula (4-2-1 rule) is:

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Correct answer: E — 50 mL/hr

The Holliday-Segar (4-2-1) formula for maintenance IV fluids: First 10 kg = 4 mL/kg/hr; Next 10 kg = 2 mL/kg/hr; Each subsequent kg = 1 mL/kg/hr. For a 15 kg child: (10 × 4) + (5 × 2) = 40 + 10 = 50 mL/hr. Isotonic balanced crystalloid (e.g., Hartmann's solution or Plasma-Lyte with 1% glucose for young children) is recommended for maintenance fluids in children to avoid hyponatraemia. Hypotonic solutions (0.18% NaCl/4% dextrose) are no longer recommended for maintenance due to the risk of hospital-acquired hyponatraemia.

Reference: NICE – 2020 – NG29 IV fluid therapy in children; APA – 2019 – Perioperative fluid guidelines