Paediatric IV Fluid Calculator — Nigeria · Kenya · Ghana
Maintenance fluids, deficit replacement and resuscitation bolus for children.
Holliday-Segar method. Fluid type guidance for Africa/South Asia resource settings.
BNF for Children 2024 · WHO Pocket Book · FMOH / MOH protocols. Offline-capable.
For qualified healthcare professionals only.
IV fluid therapy in children can be harmful if incorrectly calculated. Hyponatraemia from hypotonic fluids is a major preventable cause of harm. All recommendations sourced from BNF for Children 2024, WHO Pocket Book of Hospital Care for Children (2013), and national paediatric protocols. Always apply senior clinical judgement. Report an error
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Clinically reviewed by
Dr. Emeka Eze, FWACP (Paeds)
Paediatric Emergency Physician, Lagos University Teaching Hospital
Fluid management in paediatric emergencies requires rapid, accurate calculation across three components: resuscitation bolus for shock, deficit replacement for dehydration, and ongoing maintenance. Errors in any of these components contribute significantly to preventable paediatric morbidity and mortality in low-resource settings. WHO guidance has evolved significantly in recent years — recommending conservative fluid resuscitation in African children with febrile illness following the FEAST trial, which found that bolus fluids increased mortality in malaria-endemic settings. This tool integrates updated WHO guidance, distinguishing between fluid resuscitation for true circulatory shock versus dehydration management.
Advanced Paediatric Life Support (APLS) guidelines, 6th edition
Frequently Asked Questions
For children in circulatory shock (not malaria or dengue): 10–20 mL/kg 0.9% NaCl or Ringer's Lactate over 15–30 minutes, repeated with reassessment. In suspected severe malaria or dengue, avoid large boluses — the FEAST trial showed bolus fluids increased mortality. Use 5–10 mL/kg cautiously with close monitoring.
Deficit (mL) = percentage dehydration × weight (kg) × 10. Replace over 4 hours for severe dehydration (WHO Plan C) or correct over 24 hours for moderate dehydration alongside maintenance. Always reassess clinically after each phase.
Ringer's Lactate (Hartmann's solution) is preferred for large-volume resuscitation to reduce the risk of hyperchloraemic metabolic acidosis associated with high volumes of 0.9% NaCl. Both are appropriate for initial emergency bolus. Avoid 0.9% NaCl as a sole maintenance fluid in large volumes.
Current NICE NG29 and WHO guidelines recommend a maximum of two 10–20 mL/kg isotonic fluid boluses in most children before mandatory senior clinical review. Children who do not improve after two boluses likely have a cause of shock requiring targeted intervention (septic shock needing vasopressors, cardiogenic shock needing fluid restriction, severe anaemia needing transfusion). Administering more than 40 mL/kg without reassessment is associated with increased mortality in African children — the FEAST trial demonstrated this clearly.
The FEAST (Fluid Expansion as Supportive Therapy) trial, conducted in Uganda, Kenya and Tanzania (NEJM 2011), showed that fluid bolus therapy with saline or albumin in African children with severe febrile illness and compensated shock significantly increased 48-hour mortality compared to no bolus. This fundamentally changed paediatric fluid guidelines for sub-Saharan Africa. WHO and FMOH Nigeria now recommend cautious fluid bolusing (10 mL/kg over 30–60 minutes) with close monitoring, not the aggressive 20 mL/kg rapid boluses previously taught.
📋 Guideline basis: NICE NG29 2020 · WHO Pocket Book 2013 · APLS 6th ed · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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