IVIG Volume Per Dose
The volume of IVIG per dose depends on the patient's weight and the indication, but typically ranges from 20-200 grams per infusion, which translates to approximately 100-1000 mL of fluid volume, since most IVIG preparations are supplied at concentrations of 5-10% (50-100 mg/mL).
Standard Dosing by Indication
High-Dose Regimens (2 g/kg)
- Multisystem Inflammatory Syndrome in Children (MIS-C): 2 g/kg based on ideal body weight, which can be divided into 1 g/kg daily over 2 consecutive days in patients with cardiac dysfunction 1
- Kawasaki Disease: Single 2 g/kg infusion administered over 10-12 hours 2
- Autoimmune Dermatological Conditions: 2 g/kg distributed over 2-5 days every 4 weeks 3
Moderate-Dose Regimens (1-2 g/kg)
- Idiopathic Inflammatory Myopathies: 1-2 g/kg of ideal body weight, typically given over 2 consecutive days (1 g/kg on day 1 and day 2) monthly for 1-6 months 1
- Immune Thrombocytopenic Purpura (ITP): 1 g/kg/day for 1-2 days produces faster platelet increases compared to lower dose regimens 2, 4, 5
Low-Dose Regimens (0.4 g/kg)
- ITP Traditional Regimen: 0.4 g/kg daily for 5 consecutive days 4, 6
- Primary Immunodeficiency Maintenance: 0.2-0.5 g/kg monthly, with doses adjusted to maintain IgG trough levels >500 mg/dL 7
Practical Volume Calculations
Example for a 70 kg Adult
2 g/kg dose = 140 grams total
- At 10% concentration (100 mg/mL): 1,400 mL volume
- At 5% concentration (50 mg/mL): 2,800 mL volume
1 g/kg dose = 70 grams total
- At 10% concentration: 700 mL volume
- At 5% concentration: 1,400 mL volume
Example for a 20 kg Child
- 2 g/kg dose = 40 grams total
- At 10% concentration: 400 mL volume
- At 5% concentration: 800 mL volume
Important Dosing Considerations
Weight-Based Calculations
- Obese patients: Initial loading doses should be based on adjusted body weight (AjBW), not actual body weight, to avoid excessive dosing and unnecessary cost 8
- Standard patients: Use ideal body weight for most indications 1
Volume Management for Large Doses
- When the total IVIG dose exceeds 80 grams, consider administering over 3-5 days at 0.4 g/kg per day to reduce fluid overload risk 1
- Cardiac function and fluid status must be assessed before administration, particularly in patients with cardiac dysfunction 1
Infusion Duration
- High-dose regimens typically require "prolonged infusion over at least several hours" rather than a fixed timeframe 4
- The 2 g/kg dose for Kawasaki Disease is given over 10-12 hours 2
Common Pitfalls
- Failing to adjust for obesity: Using actual body weight in obese patients leads to excessive dosing and increased costs without additional clinical benefit 8
- Ignoring cardiac status: Large volume infusions can precipitate pulmonary edema in patients with compromised cardiac function; consider dose splitting 1
- Not checking IgA levels: IgA deficiency increases risk of severe anaphylaxis; screen before first dose and use IgA-depleted preparations if deficient 1