What is the infusion rate for 365mls of Intravenous Immunoglobulin (IVIG) containing 36.4 grams?

IVIG Infusion Rate for 365 mL (36.4 grams)

For a 365 mL IVIG infusion containing 36.4 grams, start at 0.5-1 mL/kg/hour for the first 15-30 minutes, then gradually increase by 0.5-1 mL/kg/hour every 15-30 minutes as tolerated, up to a maximum rate of 3-4 mL/kg/hour, with the total infusion typically completed over 2-4 hours depending on patient tolerance. 1

Initial Infusion Rate

• Begin infusion at 0.5-1 mL/kg/hour for the first 15-30 minutes to monitor for immediate adverse reactions 1
• For patients who have never received IVIG or have not been treated in the previous 8 weeks, proceed with particular caution as they are at higher risk for complement-mediated adverse reactions 2

Rate Escalation Protocol

• If tolerated without adverse effects, increase the rate by 0.5-1 mL/kg/hour every 15-30 minutes 1
• Maximum infusion rate should not exceed 3-4 mL/kg/hour 1
• The entire 365 mL volume will typically infuse over 2-4 hours depending on patient weight and tolerance 1

Pre-Infusion Considerations

• Administer diphenhydramine and acetaminophen as premedication to reduce infusion reactions 1
• Consider corticosteroids for patients with a history of previous infusion reactions 1
• Assess for IgA deficiency before administration, as these patients require IVIG preparations with reduced IgA levels to prevent severe anaphylaxis 1

Special Patient Populations

• Patients with cardiac dysfunction: Consider slower infusion rates or divided dosing over 2 days to minimize fluid overload risk 1
• Patients with renal dysfunction: Monitor urine output and serum creatinine closely during infusion 1
• First-time recipients: Use the most conservative initial rate (0.5 mL/kg/hour) and advance more slowly 2

Monitoring During Infusion

• Continuously monitor vital signs, particularly blood pressure and heart rate 1
• Watch for signs of infusion reactions including flushing, headache, fever, chills, or hypotension 3
• Monitor renal function parameters throughout the infusion 1

Management of Adverse Reactions

• For mild reactions (headache, flushing): Slow or temporarily stop the infusion, then resume at a slower rate 3
• For severe reactions (anaphylaxis, severe hypotension): Immediately stop the infusion, administer epinephrine, and notify the physician 1
• Most adverse effects are transient and mild, but serious complications including thrombosis, renal impairment, and hemolytic anemia can occur 3

Common Pitfalls to Avoid

• Do not infuse too rapidly in treatment-naive patients, as this significantly increases risk of adverse reactions 2
• Do not skip premedication in patients with known sensitivity or previous reactions 1
• Do not ignore early signs of infusion reactions—slowing the rate early prevents escalation 3