Neonatal maintenance fluid calculator9/11/2023 ![]() ![]() All fluid boluses for volume should be done using normal saline (0.Paediatric patients fasting for theatre & other situations still require dextrose.All neonates should receive 10% dextrose and other children should receive 5% dextrose (plus additives) at all times, unless specified by the Paediatric Unit. * hyponatraemic fluids such as 0.225%, 0.22% or 0.18% (1/5) NaCal should be avoided unless under consultation with a Consultant Paediatrician (other than in neonates as listed above).Īlmost all paediatric patients require dextrose to be added to IV fluids given the high glucose demand and metabolism of children compared with adults. * note that there is emerging evidence for the use of Plasma-Lyte 148 in maintenance and replacement fluids, although this is not yet endorsed as standard practice. Neonates maintenance fluids requiring added electrolytes (day 2+ of life available in SCN only) Neonates maintenance fluids (day 1-2 of life)ġ0% Dextrose + 0.225% NaCal + 10 mmol KCl/500ml Maintenance or replacement fluids (beware hyponatraemia - use under specialist consultation) ![]() Maintenance fluids (beware hyponatraemia - use under specialist consultation) Maintenance or replacement fluids (especially with likely Na/K losses e.g. Those available in BHS are: Pre-mixed IV fluid* Pre-mixed bags for IV fluids should be used in almost all circumstances for paediatric patients at BHS. Please ensure the intravenous fluid rates are used if looking at the RCH CPG, not the nasogastric rates.Īll paediatric IV fluids at BHS are based on and compliant with the Standards for Paediatric Fluids: NSW Health (2nd edition).Īn excellent review article of IV fluid volumes and types is available: McNab JPCH 2016. correction fluids can be calculated according to the RCH guidelines for gastroenteritis.Refer to the RCH intravenous fluids CPG and RCH maintenance fluid calculator. maintenance fluid requirements are calculated using the 4,2,1 rule (4ml/kg/hr for the first 10kg, 2ml/kg/hr for the second 10kg, and 1ml/kg/hr after that, with a maximum of 100ml/hr maintenance).all fluids should be calculated as maintenance + deficit correction + ongoing losses.This will prevent intraop hypoglycemia in these patients. Neonates and Infants who come to the OR on dextrose containing maintenance fluids should have their dextrose containing maintenance fluids continue during the case (except for brief interruptions). D10 1/4NS remains the standard maintenance fluid beyond DOL-2. Thereafter as urine output (UOP) increases, maintenance rates are increased and electrolytes (Na, K, Ca) added to the maintenance fluid mix. D10W remains the primary hourly maintenance fluid on DOL-1. Neonatal providers approach to fluid management changes and adapts based on the newborns age, maintenance needs, deficits, and ongoing losses. Therefore, no electrolytes are added to hourly maintenance fluids on DOL-1 and sometimes up to DOL-2. Maintenance of electrolyte balance in the neonate is a challenge in the context of illness or prematurity. Physiologic diuresis is observed during the first few days of life which results in 5-15% reduction in body weight by the end of the first week. ![]() Neonates have excess total body water (TBW) at birth, which must be redistributed and excreted. Hourly Fluid Requirements calculated based on the "4-2-1 Rule" provide the minimum 5mg/kg/min of glucose needed by the infant brain. These two IV solutions are also the primary IV solutions of choice to provide for hourly maintenance fluid requirements in neonates and very young infants (< 4-6 months). D10W and D10 1/4NS are the primary IV solutions used in neonates and young infants at risk for hypoglycemia. ![]()
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