HYD: Estimating Fluid Needs (2007)


Holliday MA and Segar WE. The Maintenance Need for Water in Parenteral Fluid Therapy. Pediatrics 1957;19; pg 823-832.

PubMed ID: 13431307
Study Design:
Narrative Review
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To develop two easily remembered equations for use with hospitalized patients -- one for estimating total energy expenditure based on weight alone using a relationship between weight and energy expenditure and the other for estimating maintenance fluid requirements.  

Inclusion Criteria:
None stated.
Exclusion Criteria:
None stated.
Description of Study Protocol:

This was a narrative review of selectedpublished literature related to methods for estimating energy expenditure, insensible water loss, and urinary water loss.


Data Collection Summary:
Not applicable.
Description of Actual Data Sample:
Not applicable.
Summary of Results:

"It is generally agreed that the maintenance requirements for water of individuals is determined by their caloric expenditure."

Estimated Energy Expenditure:

"By means of the following formulae, the caloric expenditure of hospitalized patients can be determined from weight alone. For weights ranging from 0 to 10 kg, the caloric expenditure is 100 cal/kg/day; from 10 to 20 kg the caloric expenditure is 1000 cal plus 50 cal/kg for each kilogram of body weight more than 10; over 20 kg the caloric expenditure is 1500 cal plus 20 cal/kg for each kilogram more than 20."

Body Weight

Estimated Energy Expenditure

0-10 kilograms

100 calories per kilogram

10-20 kilograms

1000 cal for the first 10 kg + 50 cal/kg for each kg over 10 kg.

20 kilograms and up

1500 cal + 20 cal/kg for each kg over 20 kg.

Estimated Maintenance Fluid Requirements:

  • Maintenance requirements for water depend upon insensible loss of water and renal loss.
  • An allowance of 50 ml/100 cal/ day will replace insensible loss of water, and 66.7 ml/100 cal/day will replace the average renal loss so that the total requirement is 116.7 ml/100 cal/day. As water of oxidation will supply approximately 16.7 ml/100 cal/day, the remaining 100 ml/100 cal/day must be supplied to meet the remaining water losses of patients on parenteral fluid therapy.
  • Maintenance requirements of sodium, chloride and potassium are 3.0, 2.0 and 2.0 mEq/100 cal/day, respectively.
Author Conclusion:

"Fortuitously then, average needs for water expressed in milliliters equals estimated energy expenditure in calories. These figures provide only maintenance needs for water. It is beyond the scope of this paper to consider repair of deficits or replacement of continuing abnormal losses of water. These must be considered separately and must be added to the needs for maintenance."



Funding Source:
University/Hospital: Indiana University Medical Center
Reviewer Comments:

This article did not meet the criteria for inclusion in the hydration evidence analysis project; however it is presented here for its historic relevance.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? N/A
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? Yes