RT Book, Section
A1 Rozenfeld, Ranna A.
SR Print(0)
ID 1152488434
T1 Maintenance Fluids
T2 The PICU Handbook
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259834370
LK accesspediatrics.mhmedical.com/content.aspx?aid=1152488434
RD 2024/04/19
AB Parenteral  fluids  are  typically  administered  to  patients  whose  spontaneous  and/or  enteral  intake  is  insufficient  to  meet  physiologic  needs.  Delivering  a  particular  quantity  of  water,  dextrose,  and  electrolytes  every  hour  at  a  weight-based  “maintenance  rate”  is  intended  to  meet  the  cellular  requirements  for  basic  functionality.  The  widely  used  formula  for  calculating  this  rate  (the  “4-2-1  rule”)  was  developed  in  1957  and  was  popularized  as  much  for  simplicity  as  for  accuracy.  Its  original  proponents  utilized  a  rough  estimate  of  patient  energy  requirements  to  extrapolate  fluid  needs,  escalating  stepwise  with  increases  in  weight,  to  arrive  at  the  “4-2-1”  progression.  This  approximation  results  in  a  “maintenance”  hourly  value  providing  the  necessary  intake  to  meet  a  minimum  of  one's  basal  metabolic  needs,  but  likely  not  those  accompanying  routine  physical  activities.  It  is  worth  noting  that  this  formula  was  developed  based  on  data  from  hospitalized,  bedridden  patients.1