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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 46 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 runs by pump at 120 mL/h. At 21:30, 650 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL650 mL infused120 mL/h
t = h
3.IV infusion ratesMedium
500 mL was ordered over 6 hours. After 3 hours you find that 280 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?
500 mL / 6 hafter 3 h: 280 mL
R = mL/h
4.IV infusion ratesHard
A drip runs at 40 gtt/min through a set of 60 gtt/mL. There are 900 mL left in the bag. How many hours t until it is empty?
40 gtt/min60 gtt/mL900 mL
t = h
3Solutions
1.IV fluids & fluid balance
Answer: U = 1.54 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
225 + 475 + 150 = 850 mL
Per kilogram per hour
U = 850/(46·12) = 1.54 mL/kg/h
Answer
U = 1.54 mL/kg/h
2.IV fluids & fluid balance
Answer: t = 2.9 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.
Volume left
1000 − 650 = 350 mL
Time
t = 350/120 = 2.917 ≈ 2.9 h
Answer
t = 2.9 h
That is about 2 h 55 min, so the bag runs out at about 00:25.
3.IV infusion rates
Answer: R = 93.33 mL/h
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
500/6 = 83.33 mL/h
New rate
R = 280/3 = 93.33 mL/h
Answer
R = 93.33 mL/h
Many hospitals allow such an adjustment up to 25% without a new order; check local policy.
4.IV infusion rates
Answer: t = 22.5 h
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.