The nurse is caring for a child in the ER who has been vomiting and needs to calculate maintenance fluids. The child weighs 96.8 lbs. How many milliliters should the nurse administer over 24 hours? What is the hourly rate? Round to the nearest whole number.

Step 1: Convert the child’s weight from pounds to kilograms. 96.8 lbs ÷ 2.2 = 44 kg Result at step 1 = 44 kg Step 2: Apply the Holliday-Segar formula. For the first 10 kg: 100 mL/kg × 10 kg = 1000 mL For the next 10 kg: 50 mL/kg × 10 kg = 500 mL For the remaining weight (44 kg - 20 kg = 24 kg): 20 mL/kg × 24 kg = 480 mL Result at step 2 = 1000 mL + 500 mL + 480 mL = 1980 mL Step 3: Adjust for vomiting. Since the child has been vomiting, maintenance fluids are typically not increased unless specified (e.g., for dehydration). The question asks for maintenance fluids, so we use the standard calculation from Step 2. Result at step 3 = 1980 mL for 24 hours Step 4: Calculate the hourly rate. 1980 mL ÷ 24 hours = 82.5 mL/hour Result at step 4 = 82.5 mL/hour Step 5: Round to the nearest whole number. 82.5 rounded to the nearest whole number = 83 mL/hour Final answer 83 mL/hour