IVIG Protocol- Addenbrooke's Hospital (For use in Vasculitis and Lupus)

Dose:
0.67 g/kg for 3 days (ie Total Dose is 2g/kg).

0.4g/kg for 5 days for patients with history of thrombosis

0.4g/kg for 5 days for patients > 60y/o

0.4g/kg for 5 days for Serum Creatinine > 150umol/l

Give 1st 5g bottle over 1 hour.
Then subsequent bottles at 1/2 hour each.


Side Effects:
IVIG is potentially nephrotoxic!
(ARF can occur in pt with pre-existing renal impairment. Renal recovery is usually complete within 10 days)
(But I have seen 1 doctor's dad who went into ESRD following IVIG infusions. Please be careful)
Common side effects: fever, chills, backache, malaise.
Headache/Backache and chills usu respond to slowing of the infusion rate
Rarely, allergic reactions occur.
Patients with autoimmune disease often experience 'flu-like' symptoms and headaches for 7-10days after IVIG infusion.
Rarely, they may experience rashes and other inflammatory phenomena.



Haemodialysis patients:
Dose: 0.67g/kg given after 3 consecutive dialysis sessions (Total dose 2g/kg)
IVIG can be administered through the venous return limb of the extracorporeal circuit.
IVIG may be started during the HD session or given entirely at the end of the HD session via the venous limb of the fistula.
Following completion of the infusion, it is safe for the patient ot go home 1 hour after initial treatment.

CAPD patients:
As in normal patients but beware of fluid overload.