IV Fluid Maintenance Calculator (Holliday-Segar)
Calculate maintenance intravenous fluid rate using the validated Holliday-Segar 4-2-1 formula. Adjust for dehydration, fasting, or surgical scenarios.
IV orders, intake/output, and shift handovers — all in one place
EasyClinic auto-calculates maintenance fluids on admission, generates printable IV orders, and tracks total fluid balance across nursing shifts. Built for IPD.
Also Known As
The Holliday-Segar Formula Explained
The Holliday-Segar formula (also called the 4-2-1 rule) is the standard method for calculating maintenance intravenous fluid requirements in pediatric and adult patients. Published in 1957 by Drs. Malcolm Holliday and William Segar, it remains the most widely-used IV fluid calculation in hospitals worldwide.
Daily Requirement:
- First 10 kg: 100 mL/kg/day
- Next 10 kg (10-20 kg): +50 mL/kg/day
- Each kg above 20 kg: +20 mL/kg/day
Hourly Rate (4-2-1):
- First 10 kg: 4 mL/kg/hour
- Next 10 kg: +2 mL/kg/hour
- Each kg above 20 kg: +1 mL/kg/hour
When to Use This IV Fluid Calculator
This pediatric and adult IV fluid maintenance calculator is essential for emergency physicians, pediatricians, internists, anesthesiologists, intensivists, and ward nurses managing inpatients across India — from district hospitals in UP and Bihar to tertiary care centres like AIIMS, PGI Chandigarh, CMC Vellore, Apollo, Fortis, Manipal, and Max hospitals.
Common clinical scenarios: post-operative patients, dehydrated children with gastroenteritis, NBM (nil by mouth) pre-procedure patients, septic shock resuscitation, burns, diabetic ketoacidosis (DKA) — though specific protocols (like DKA fluid management) require additional considerations beyond simple maintenance calculation.
Choice of IV Fluid in 2026 — Modern Recommendations
Modern evidence (NICE NG29, 2015; updated SPLIT and PLUS trials) recommends isotonic balanced crystalloids (Ringer's Lactate or Plasma-Lyte) over 0.45% saline for routine maintenance to prevent hospital-acquired hyponatremia, especially in children. For pediatric patients, D5 in 0.9% NaCl (D5NS) is now preferred over hypotonic D5 in 0.45% NaCl.
Frequently Asked Questions
▸What is the 4-2-1 rule for IV fluids?
4 mL/kg/hour for the first 10 kg + 2 mL/kg/hour for the next 10 kg + 1 mL/kg/hour for every kg above 20 kg. This gives the maintenance hourly fluid requirement.
▸How do I calculate IV fluid for a 25 kg child?
Using 4-2-1: 40 (first 10kg) + 20 (next 10kg) + 5 (kg 21-25) = 65 mL/hour. Daily total: 1500 + 100 = 1600 mL/day.
▸What IV fluid should I use for maintenance?
Modern guidelines (NICE NG29, 2015) recommend isotonic balanced crystalloids (Ringer's Lactate) or D5NS for pediatric maintenance to prevent iatrogenic hyponatremia.
▸How do I convert mL/hour to drops/minute?
For a macrodrip set (15 drops/mL): drops/min = (mL/hr × 15) / 60. For a microdrip pediatric set (60 drops/mL): drops/min = mL/hour directly.
▸Should I increase fluids for fever?
Yes, increase by 10-12% for every 1°C rise above 37°C in sustained fever. Account for insensible losses.
▸Can the Holliday-Segar formula be used in adults?
Yes, it works for adults but typically gives 2400-2600 mL/day for a 70kg adult. Most hospitals cap maintenance at ~2400 mL/day in healthy adults.
References
- Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823
- NICE Guideline NG29: Intravenous fluid therapy in children and young people
- IAP Guidelines on IV Fluid Therapy in Children (2018)
Document IV orders without leaving the chart
EasyClinic auto-calculates maintenance fluids on patient admission, suggests appropriate fluid type (RL/NS/D5NS), and tracks total intake/output across nursing shifts.