What is the IV infusion titration for a 92kg patient receiving 36.4 grams of Intravenous Immunoglobulin (IVIG) in a 364mL solution?

IVIG Infusion Titration Protocol for 92kg Patient Receiving 36.4g (364mL)

For this 92kg patient receiving 36.4 grams of IVIG, administer the infusion over 4-6 hours for the first dose, starting at a slow rate and gradually increasing as tolerated, with subsequent doses potentially given over 2-4 hours if well-tolerated. 1

Pre-Infusion Preparation

Premedication:

• Administer diphenhydramine 1 mg/kg (approximately 92mg for this patient) 1
• Administer acetaminophen 10-15 mg/kg (approximately 920-1380mg for this patient) 1
• Consider corticosteroids if the patient has a history of infusion reactions 2

Pre-Assessment:

• Check baseline vital signs before starting 1
• Ensure adequate hydration 1
• Verify IgA levels have been checked to prevent severe anaphylaxis in IgA-deficient patients 2, 1
• Review renal function, as monitoring is required during administration 2

Infusion Rate Titration

Initial Infusion (First Dose):

• Start slowly: Begin at 0.5-1 mL/kg/hour (46-92 mL/hour for this 92kg patient) for the first 30 minutes 3
• Gradual increase: If tolerated without adverse reactions, increase by 0.5 mL/kg/hour every 15-30 minutes 3
• Target rate: Work up to a maximum of 3-4 mL/kg/hour (276-368 mL/hour) as tolerated 3
• Total duration: Complete the 364mL infusion over 4-6 hours 1

Subsequent Infusions:

• If the first infusion was well-tolerated, subsequent doses may be administered over 2-4 hours 1
• Use the same gradual titration approach but may reach target rate more quickly 1

Monitoring Protocol

Vital Sign Monitoring:

• Check vitals every 15-30 minutes during the first hour 1
• Check hourly thereafter if stable 1
• Monitor continuously for signs of adverse reactions 3

Parameters to Monitor:

• Blood pressure, heart rate, respiratory rate, temperature 1
• Renal function including urine output and serum creatinine 2
• Signs of fluid overload, particularly in patients with cardiac dysfunction 2

Management of Adverse Reactions

If Mild Reactions Occur (flushing, headache, malaise):

• Slow or temporarily stop the infusion 3
• Administer additional antihistamines or acetaminophen 3
• Resume at a slower rate once symptoms resolve 3

If Severe Reactions Occur (anaphylaxis, severe hypotension):

• Immediately stop the infusion 2
• Administer epinephrine 2
• Notify physician immediately 2

Important Clinical Caveats

• Do not administer plasmapheresis immediately after IVIG, as it will remove the immunoglobulin 1
• Patients with cardiac dysfunction may benefit from divided dosing (splitting the dose over 2 days at 1 g/kg daily) to minimize fluid overload 2
• The majority of adverse effects are transient and mild, but rare serious complications include renal impairment, thrombosis, and hemolytic anemia 3
• Infusing at a slow rate and premedicating can minimize adverse effects 3