What is the hourly fluid maintenance rate for a 13.5 kg child?

Choice A reason: A 109 ml/hour rate is excessive for a 13.5 kg child. Using the 4-2-1 rule (4 ml/kg/hour for the first 10 kg, 2 ml/kg/hour for the next 3.5 kg), the total is 47 ml/hour, not 109, which could cause fluid overload and cardiovascular strain. Choice B reason: A 79 ml/hour rate overestimates maintenance fluids for a 13.5 kg child. The 4-2-1 rule yields 47 ml/hour (40 ml for 10 kg + 7 ml for 3.5 kg). Higher rates risk hypervolemia, potentially causing pulmonary edema or electrolyte imbalances in a child. Choice C reason: For a 13.5 kg child, the 4-2-1 rule calculates maintenance fluids as 40 ml/hour (10 kg × 4 ml) + 7 ml/hour (3.5 kg × 2 ml) = 47 ml/hour, closest to 49 ml/hour. This rate maintains hydration without risking fluid overload, supporting renal and cardiovascular function. Choice D reason: A 200 ml/hour rate is far too high for a 13.5 kg child, risking fluid overload, heart failure, or pulmonary edema. The correct maintenance rate, per the 4-2-1 rule, is approximately 47 ml/hour, making this choice dangerously excessive for pediatric fluid needs.