Holliday-Segar — Paediatric Maintenance Fluids Nigeria · Kenya · Ghana
Weight-based daily and hourly maintenance fluid calculation using the Holliday-Segar (4/2/1) method.
Fluid type guidance for African resource settings. Special adjustments for malnutrition, malaria, and postoperative care.
BNF for Children 2024 · WHO Pocket Book · NICE NG29. Offline-capable.
For qualified healthcare professionals only.
Holliday-Segar rates are screening estimates only — not final fluid orders. Adjust for ongoing losses, fever, clinical condition, sodium/glucose, and renal function. Never use hypotonic fluids as maintenance in paediatric inpatients — risk of hospital-acquired hyponatraemia.
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Clinically reviewed by
Dr. Chioma Okafor, FWACP (Paeds)
Consultant Paediatrician, University of Nigeria Teaching Hospital
Accurate maintenance fluid calculation is a fundamental paediatric clinical skill. The Holliday-Segar method, published in 1957 and based on metabolic rate, remains the standard formula for estimating daily fluid requirements in children. The formula calculates 100 mL/kg for the first 10 kg of body weight, 50 mL/kg for the next 10 kg, and 20 mL/kg for each kilogram above 20 kg — reflecting decreasing fluid needs per unit of body weight as children grow. Errors in fluid prescription — both over-administration causing fluid overload and under-administration causing dehydration — carry significant morbidity in paediatric patients. This calculator helps clinicians rapidly derive accurate maintenance rates in busy, low-resource ward settings across Nigeria, Kenya and Ghana.
References & Guidelines
Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–832.
The formula calculates daily maintenance fluid needs: 100 mL/kg for the first 10 kg + 50 mL/kg for the next 10 kg + 20 mL/kg for each kg above 20 kg. Example: a 25 kg child needs (10×100) + (10×50) + (5×20) = 1,000 + 500 + 100 = 1,600 mL/day.
The 4-2-1 rule gives hourly rates equivalent to Holliday-Segar: 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg, 1 mL/kg/hr for each kg above 20 kg. The 25 kg child above would receive 4×10 + 2×10 + 1×5 = 40 + 20 + 5 = 65 mL/hr.
NICE NG29 recommends isotonic 0.9% NaCl with 5% glucose as the standard maintenance fluid for children to reduce the risk of hyponatraemia — previously common with hypotonic fluids. Add KCl 20 mmol/L once urine output is confirmed. Always adjust for clinical context.
The Holliday-Segar formula is appropriate for most healthy children as a baseline maintenance fluid calculation. However, it must be used with caution in children with cardiac disease, renal impairment, liver failure, hyponatraemia, meningitis, or post-operative states where fluid restriction is indicated. NICE NG29 recommends isotonic fluids (0.9% NaCl with glucose) for paediatric maintenance rather than hypotonic solutions, which carry hyponatraemia risk.
Iatrogenic hyponatraemia occurs when hypotonic IV fluids are given in excessive volumes, causing dilutional lowering of serum sodium. Historically, Holliday-Segar calculations were paired with hypotonic fluids (0.18% NaCl or 0.45% NaCl), which caused deaths. Current guidance (NICE NG29, WHO) mandates isotonic saline (0.9% NaCl) with or without glucose for all routine paediatric maintenance to eliminate this risk. The volume calculation remains valid; the fluid choice changed.