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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 patient weighs 74 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 12:30 and runs by pump at 150 mL/h. How many mL V are left in the bag at 18:00?
1000 mL150 mL/h12:30 → 18:00
V = mL
3.IV infusion ratesMedium
An infusion is ordered at 90 mL/h, but no pump is available. It runs by gravity through a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.
90 mL/h10 gtt/mL
R = gtt/min
4.IV infusion ratesHard
1000 mL was ordered over 10 hours. After 3 hours you find that 780 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?
1000 mL / 10 hafter 3 h: 780 mL
Δ = %
3Solutions
1.IV fluids & fluid balance
Answer: U = 0.9 mL/kg/h
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.
Total urine
400 + 175 + 225 = 800 mL
Per kilogram per hour
U = 800/(74·12) = 0.9009 ≈ 0.9 mL/kg/h
Answer
U = 0.9 mL/kg/h
2.IV fluids & fluid balance
Answer: V = 175 mL
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.
Elapsed time
12:30 → 18:00 = 5.5 h
Volume infused
150·5.5 = 825 mL
Volume left
V = 1000 − 825 = 175 mL
Answer
V = 175 mL
3.IV infusion rates
Answer: R = 15 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.
Millilitres per minute
90/60 = 1.5 mL/min
Drip rate
R = 1.5·10 = 15 gtt/min
Answer
R = 15 gtt/min
4.IV infusion rates
Answer: Δ = 11.43 %
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.
Original rate
1000/10 = 100 mL/h
New rate
R = 780/7 = 111.4 mL/h
Percentage change
Δ = (111.4 − 100)/100·100% = 11.43%
Answer
Δ = 11.43%
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.