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1Formulas and methods
IV fluids & fluid balance
Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time
IV infusion rates
Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)
Method
Pump rate in mL/h: volume divided by time in hours.
Drip rate in drops/min: volume × drop factor divided by time in minutes.
For time remaining: volume left divided by the rate.
Round as the question or the equipment requires.
2Practice problems
1.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
tea: 150 mLmilk: 240 mLice chips: 120 mLIV infusion: 100 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
2.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 11:00 at 120 mL/h. After 2 hours the rate is changed to 100 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL120 mL/h · 2 h100 mL/h
t = h
3.IV infusion ratesMedium
Infuse 500 mL over 6 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
500 mL6 h15 gtt/mL
R = gtt/min
4.IV infusion ratesHard
250 mg of a drug is diluted in 250 mL and given by gravity through a set of 15 gtt/mL. The order is 60 mg per hour. Find the drip rate R in drops per minute.
250 mg/250 mL60 mg/h15 gtt/mL
R = gtt/min
3Solutions
1.IV fluids & fluid balance
Answer: I = 1700 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Add the intake
oral: 150 + 240 = 390 mL
ice chips: 120/2 = 60 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 1·50 = 50 mL
I = 1700 mL
Answer
I = 1700 mL
2.IV fluids & fluid balance
Answer: t = 4.6 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
120·2 = 240 mL
500 − 240 = 260 mL left
Second part
260/100 = 2.6 h
Total time
t = 2 + 2.6 = 4.6 h
Answer
t = 4.6 h
That is about 4 h 36 min, so the bag runs out at about 15:36.
3.IV infusion rates
Answer: R = 21 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Time in minutes
6·60 = 360 min
Drip rate
R = 500·15/360 = 20.83 ≈ 21 gtt/min
Answer
R = 21 gtt/min
At the bedside you round to the nearest whole drop: 21 gtt/min.
4.IV infusion rates
Answer: R = 15 gtt/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).