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Malcolm Holliday, MD, (d. 2014) was a pediatric nephrologist and physiologist. Dr. Holliday’s original work studying inherited tubular disorders and congenital renal defects eventually led him to become professor of pediatrics and chief of the Division of Pediatric Nephrology at University of California San Francisco, a position he held for over two and a half decades of his 60 year career.
In anesthetic practice, this formula has been further simplified, with the hourly requirement referred to as the “4-2-1 rule” (4 mL/kg/hr for the first 10 kg of weight, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for each kilogram thereafter.
The 4-2-1 rule is a simplified method for estimating hourly maintenance fluid requirements in pediatric patients. The 4-2-1 rule provides an alternative approach to the Holliday-Segar formula, which calculates daily fluid requirements.
In many cases, a simple calculation called the 4-2-1 rule can determine the hourly rate of fluid maintenance required for a child based on their body weight. [13] The formula outlined below illustrates its application, where fluid maintenance rates are calculated based on the following criteria:
A 32 kg child needs 72 ml of maintenance fluids per hour using the 4-2-1 rule, totaling 1728 ml per day. Use Maintenance fluid calculator to calculate daily maintenance fluids and fluid flow rate (mL/hr) at once.
Recommendations. Maintenance IV fluids are appropriate for euvolemic patients who cannot take adequate enteral fluids. Calculate hourly maintenance fluid rates using standard weight-based formula (4-2-1 rule)
The maintenance fluids calculator (MIVF calculator) uses the Holliday-Segar method and the 4-2-1 rule to determine the daily and hourly need for fluids in children. As well as finding out these pediatric maintenance fluids, you can also work out the proper size of the pediatric fluid bolus to be given in times of need.
Holliday-Segar “4-2-1” Rule: No or Not candidate for enteral. “IV Fluid Therapy: First 1-10 kg = 4 mL/kg/hr. Next 11-20 kg = 2 mL/kg/hr. Next > 20 kg = 1 mL/kg/hr. Add together for maintenance rate. Calculation example. BSA method: • BSA (m2) × 1600 mL/m2/day = Daily requirement.
This calculator determines the fluid requirement that needs to be corrected in pediatric patients based on weight (because total body water relies on weight). There are two calculation methods used, the Holliday-Segar nomogram and the 4 – 2 – 1 rule.
4 2 1 Fluid Rule. Prehospital providers are drilled with the standard PALS formula for fluid resuscitation, 20ml/kg, or 10ml/kg for infants. These bolus fluids are indicated for patients suffering from gastrointestinal illness, poor oral intake, or traumatic injuries where hemodynamic status is compromised.