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FluidReplacement

Three part formula for deriving amounts of fluid to be replaced:
A. Deficit is defined as the time the patient is NPO to the time surgery begins
1. 4 ml/kg/hr for the first 0-10 kg
2. 2 ml/kg/hr for the next 11-20 kg
3. 1 ml/kg/hr for weight greater than 21 kg 

Maintenance is defined as the time of incision to closure (dependent on the type of surgicalprocedure)

1. Eye surgery, extremity procedure 5 ml/kg/hr
2. Mastectomy 8 ml/kg/hr 
3. Minor abdominal procedure 8-10 ml/kg/hr
4. Laparotomy/resection, thorocotomy 12 ml/kg/hr 
5. Extensive procedure 15-20 ml/kg/hr

C. Blood replacement: ml/ml for blood replacement plus 3 ml/ml crystalloid to estimated blood loss or 1 ml/ml of volume expander such as albumin

Schedule for replacement during the surgical procedure: 
A. First hour: ½ the deficit + maintenance + blood replacement
B. Second hour: ¼ the deficit + maintenance + blood replacement
C. Third hour: ¼ the deficit + maintenance + blood replacement

REFERENCE
ASPAN, Redi-Ref 2004: Ambulatory/PACU/Pediatric (Ireland, D, Ed.). 10 Melrose Ave, Suite 110, Cherry Hill, NJ, p. 72, 2004.
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