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Calculation of Fluid Needs or Limits

The document discusses fluid needs and limits for infants and pediatric patients receiving enteral nutrition. It notes that infants have high fluid needs due to their large surface area, high percentage of body water, and limited renal capacity. Three methods for calculating maintenance fluid requirements are described: based on body surface area, body weight, or energy expended. The intake of water should maintain normal serum sodium levels and urine output. Factors like age, disease states, activity level, and environmental conditions can impact fluid requirements. Careful monitoring of fluid balance is important for patients receiving enteral nutrition or concentrated formulas.

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236 views2 pages

Calculation of Fluid Needs or Limits

The document discusses fluid needs and limits for infants and pediatric patients receiving enteral nutrition. It notes that infants have high fluid needs due to their large surface area, high percentage of body water, and limited renal capacity. Three methods for calculating maintenance fluid requirements are described: based on body surface area, body weight, or energy expended. The intake of water should maintain normal serum sodium levels and urine output. Factors like age, disease states, activity level, and environmental conditions can impact fluid requirements. Careful monitoring of fluid balance is important for patients receiving enteral nutrition or concentrated formulas.

Uploaded by

PCMC Dietitians NDD
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Fluid Needs or Limits

The availability of free water is an essential consideration in choosing infant and


pediatric enteral products. Fluid management is especially important in infants
because of the following:

 Large body surface area


 High percentage of body water and its high rate of turnover
 Limited renal capacity for handling solute load
 Susceptibility to dehydration due to inability to express thirst (Groh-Wargo,
2000)

Fluid requirements vary with age and disease states (Heyland, 2001). The following
three methods, each with its own limitations, have been proposed to calculate
maintenance fluids (Thomas, 2007):

1. Body surface area (1,500 mL/m2 to 1,700 mL/m2)


2. Body weight:

1-10 kg = 100 mL/kg

11-20 kg = 1,000 mL + 50 mL/kg for each kg >10 kg

>20 kg = 1,500 mL + 20 mL/kg for each kg >20 kg

3. Energy expended (100 mL/100 kcal)

The intake of water should promote or produce the following ( Hay, 1991; Leichty,
1998; Holliday, 1988):

 Serum sodium within the normal range


 Urine with a specific gravity of 1.010 g/mL to 1.016 g/mL
 Flow of 2 mL/kg/hr to 6 mL/kg/hr and maintain urine osmolality around 200
mOsm/kg to 400 mOsm/kg water.

Infants and children receiving enteral nutrition usually tolerate fluid intakes of more
than maintenance needs (AAP, 2009; Nevin-Folino, 2005). Most infants who weigh 10
kg or less will require more than basic maintenance fluid requirements from their
daily enteral formula volume in order to meet their energy, macronutrient, and
micronutrient needs. For pediatric patients receiving enteral nutrition, several factors
may alter fluid maintenance requirements.

Insensible water losses increase in the following conditions:

 Rise in body temperature (+13% per degree centigrade)


 Elevated environmental temperatures (50% to 100%)
 Visible sweating (5 mL/100 kcal/day to 25 mL/100 kcal/day)
 Increased activity
 Respiratory distress
 Metabolic acidosis
 Cardiorespiratory disease
 Skin breakdown
 Phototherapy

Insensible water losses decrease in the following conditions:

 Humidified air
 Ventilator or tracheostomy collar
 Topical agents
 Humidified incubator

Daily water loss in urine and stool, and insensible loss as a function of age are shown
in the table.

Maintenance Water Loss Components Based on Age (mL/kg/d)


Component 0-6 m 6m-5y 5 - 10 y >10 y

Insensible 40 30 20 10

Urinary 60 60 50 40

Fecal 20 10 – –

Total 120 100 70 50

(Thomas, 2007)

In general, enteral formulas contain approximately 70% to 90% free water. Fluid
restrictions may be required for some cardiac, renal, liver, or respiratory conditions. In
addition, children with neuromuscular disease and other neurological disorders, such
as cerebral palsy, may be at risk for not receiving sufficient free water and they may
not be able to let their caregivers know they are thirsty (AAP, 2009). In an attempt to
minimize the risk of aspiration or better manage their tube-feeding schedules with
both nocturnal feeds and daytime bolus feedings, these children are often on
concentrated formulas with inadequate free water intake to meet their fluid
needs. As a result, dehydration and subsequent problems such as constipation or
metabolic complications can occur.

The fluid balance of children on high-energy, high-protein formulas should be


carefully monitored; moreover, conditions such as emesis, diarrhea and fever can
further increase the risk for dehydration in chronically ill children (AAP, 2009).

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