Percent cumulative fluid balance (fluid overload %)
- Category: Fluids and resuscitation
- Version: v1.0.1
- Reviewed: Reviewed 6 Sep 2026
- Validation: Validation pending
Both published forms are shown, because the Pediatric ADQI consensus prints both without choosing between them. Fluid-based form: (cumulative intake − cumulative output, in litres) × 100 ÷ anchor weight in kilograms. Weight-based form: (current weight − anchor weight, in kilograms) × 100 ÷ anchor weight in kilograms. Both divide by the ANCHOR weight, never the current one. Negative results are real (diuresis, ultrafiltration) and are reported as such. The two forms agree only when every retained millilitre was charted and all mass change is fluid; insensible losses usually put the weight-based figure BELOW the fluid-based one. The raw balance in mL and the raw weight change in kg are emitted alongside the percentages.
NO BANDS, DELIBERATELY. The well-known 10% and 20% figures are cohort associations measured at CRRT initiation in children already on renal replacement therapy: observed mortality was 29.4% below 10%, 43.1% at 10-20%, and 65.6% at or above 20%, with an adjusted OR of 1.03 per 1% and an OR of 8.5 at or above 20% (Sutherland 2010). The lowest stratum is a population with near-30% mortality, which is a statement about who receives CRRT rather than about what 9% means on a ward. ADQI states that no threshold alone can define fluid overload across all sick children. FAILURE MODES: uncharted output returns a confidently over-positive percentage with no sign anything is missing. The weight-based form measures mass, so catabolism understates and growth overstates fluid, and scale technique bites hardest in the smallest patients.
References
- Goldstein SL, Currier H, Graf CD, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107(6):1309-1312.Origin of the metric: fluid accumulation as a percentage of body weight in critically ill children.PMID 11389248DOI 10.1542/peds.107.6.1309
- Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the Prospective Pediatric Continuous Renal Replacement Therapy Registry. Am J Kidney Dis. 2010;55(2):316-325.Formula stated verbatim; source of the <10% / 10-20% / >=20% strata and their observed mortality (29.4% / 43.1% / 65.6%), the adjusted OR of 1.03 per 1%, and the OR of 8.5 at >=20% — associations in a CRRT cohort, NOT interpretation bands.PMID 20042260DOI 10.1053/j.ajkd.2009.10.048
- Selewski DT, Cornell TT, Lombel RM, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med. 2011;37(7):1166-1173.Validates the weight-based form as a practical substitute for the fluid-based form; UNIVARIATE per-1% PICU-mortality OR 1.044 (weight-based, PICU admission weight) vs 1.056 (fluid-balance method). On multivariate analysis all three methods only APPROACHED significance.PMID 21533569DOI 10.1007/s00134-011-2231-3
- Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32(8):1771-1776.Supporting paediatric CRRT fluid-overload literature. Cited as lineage only — no numeric value in this implementation is taken from it.PMID 15286557DOI 10.1097/01.ccm.0000132897.52737.49
- Selewski DT, Barhight MF, Bjornstad EC, Ricci Z, de Sousa Tavares M, Akcan-Arikan A, Goldstein SL, Basu R, Bagshaw SM; Pediatric Acute Disease Quality Initiative (ADQI) Consensus Committee. Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference. Pediatr Nephrol. 2024;39(3):955-979. Epub 2023 Nov 7.Current consensus. Prints BOTH formulae in Table 1 without choosing; defines 'fluid overload' as a pathologic state of positive fluid balance associated with clinically observable event(s), with 'percent cumulative fluid balance' as the neutral descriptor; states no specific threshold of positive fluid balance alone can define fluid overload across all sick children; names anchor-weight selection a knowledge gap with no gold standard.PMID 37934274DOI 10.1007/s00467-023-06156-wSource
Reproduction rights
Freely reproducible.Both forms are elementary arithmetic over measured volumes and weights — one subtraction, one multiplication by 100, one division. Mathematical formulae and the measurements they operate on are facts, not copyrightable expression. There is no item wording, no response descriptor and no table to license, and no rights claim appears in Goldstein 2001, Sutherland 2010, Selewski 2011 or the Pediatric ADQI consensus (fluid-balance.md IP status).
Independent clinical validation: pending
Two independent clinical validators will be named here once review is complete.
- 2026-09-03v1.0.0Initial releaseInitial published text.
- 2026-09-06v1.0.1ClarificationAdded a one-line description for the catalogue card and shortened field guidance to fit an info toggle. No rule, threshold or reference changed.
Other fluids and resuscitation scores
Important. For use by qualified health professionals as an informational and educational aid. It supports clinical judgment and does not replace it. Verify every result independently before making a clinical decision. This is not a medical device.