Holliday-Segar formula

The Holliday-Segar formula is a formula to help approximate water and caloric loss (and therefore the water requirements) using a patient's body weight.[1] Primarily aimed at pediatric patients, the Holliday-Segar formula is the most commonly used estimate of daily caloric requirements.[2] To date, the formula continues to be recommended in the the current clinical practice guidelines of the American Academy of Pediatrics, American Society of Parenteral and Enteral Nutrition, and National Health Service.[3][4][5] Developed in 1957 by Drs. Malcolm A. Holliday and William E. Segar while at the Indiana University School of Medicine, the researchers concluded a non-linear relationship between energy expenditure and weight alone to determine fluid requirements.

The Holliday-Segar Formula
For each kilogram in this range Daily caloric cost per kilogram
1-10 kg 100 kcal/kg/day
11-20 kg 50 kcal/kg/day
>20 kg 20 kcal/kg/day

Worked Example

To estimate the daily fluid requirements of a 9-year old boy who weights 32 kg, 10*100 + 10*50 + 12*20 = 1740 kcal per day. At a 1 kcal / 1 mL conversion, the daily H20 requirements would therefore be 1740 mL.

Limitations

While generalizable to most cohorts, the Holliday-Segar formula may inadequately estimate caloric requirements in patients affected by fever, hypothermia, or increased activity states (ie, hyperthyroidism or status epilepticus).[2] The formula can also only be applied to patients above 2 weeks of age.

References

1. Holliday, M. A.; Segar, W. E. (1957). "The maintenance need for water in parenteral fluid therapy". Pediatrics. 19 (5): 823–832. ISSN 0031-4005. PMID 13431307.
2. "Dehydration in Children - Pediatrics". Merck Manuals Professional Edition. Retrieved 2021-01-12.
3. Feld, Leonard G.; Neuspiel, Daniel R.; Foster, Byron A.; Leu, Michael G.; Garber, Matthew D.; Austin, Kelly; Basu, Rajit K.; Conway, Edward E.; Fehr, James J.; Hawkins, Clare; Kaplan, Ron L. (2018). "Clinical Practice Guideline: Maintenance Intravenous Fluids in Children". Pediatrics. 142 (6): e20183083. doi:10.1542/peds.2018-3083. ISSN 0031-4005. PMID 30478247.
4. Mehta, Nilesh M.; Skillman, Heather E.; Irving, Sharon Y.; Coss-Bu, Jorge A.; Vermilyea, Sarah; Farrington, Elizabeth Anne; McKeever, Liam; Hall, Amber M.; Goday, Praveen S.; Braunschweig, Carol (2017). "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition". Journal of Parenteral and Enteral Nutrition. 41 (5): 706–742. doi:10.1177/0148607117711387. ISSN 0148-6071. PMID 28686844.
5. Moritz, Michael L.; Ayus, Juan C. (2015-09-30). "Maintenance Intravenous Fluids in Acutely Ill Patients". New England Journal of Medicine. 373 (14): 1350–1360. doi:10.1056/nejmra1412877. PMID 26422725. Retrieved 2021-01-12.