Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Using the 100–50–20 rule, what is the daily maintenance fluid requirement for a 15 kg child?
The mother of a 5-day-old breastfed baby asks how she can tell her baby is getting enough milk. Which answer is best?
Practice exercise (made-up values, not clinical guidance). An infusion of 100 units of regular insulin in 250 mL runs at 10 mL/h. How many units per hour D does the patient receive?
Practice exercise (made-up values, not clinical guidance). A patient who weighs 87 kg has an order for norepinephrine at 6 mcg/min. The bag contains 8 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.
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.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 16:00 at 80 mL/h. After 2 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
Answer: A · 1250 mL per day
First 10 kg: 10 × 100 = 1000 mL. Next 5 kg: 5 × 50 = 250 mL. Total = 1250 mL per day, or about 52 mL per hour.
Answer: B · About 6 or more wet nappies a day, regular yellow stools and steady weight gain
After the first few days, signs of good intake include at least about 6 heavy wet nappies a day, frequent yellow stools, contented behaviour after feeds and weight gain. Most babies regain their birth weight by about 2 weeks.
Answer: D = 4 units/h
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: R = 11.3 mL/h
Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
The order is per minute for the whole patient, so the weight is not needed.
Answer: I = 1640 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.
Answer: t = 7.7 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.
That is about 7 h 40 min, so the bag runs out at about 23:40.
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