A🧵on
Intravenous Immunoglobulin - Dosing considerations in Guillain-Barré syndrome
First a question ❓️
A 120kg male diagnosed with Gullian Barre syndrome was planned to be given IVIG.
What is the total dose to be given ❓️
Is there an alternate dosing protocol in obese patients❓️
⭕️Intravenous Immunoglobulin and plasmapheresis are the main therapeutic interventions in management of GBS.
IVIG is costly and the dose in GBS is calculated as 400mg/day for 5 days or 2gm/kg total divided among 5 days.
Practically total dose is calculated as 2gm/ kg and then divided among 5 days.
IVIG comes in two concentrations in 🇮🇳
🔸️5% 100ml containing 5g
🔸️10% 100ml containing 10g
The main issue is that the dose is weight based and as weight increases the dose increases as does the cost !
Let's calculate the dosing in 73kg patient
Total dose = 73 x 2 = 146gm
Now it's divided among 5 days
Day 1 - 30
Day 2 - 30
Day 3 - 30
Day 4 - 30
Day 5 - 25
We approximate to the nearest 5 gm dose. Give maximum dose on first day. Give least on fifth day.
Infusion as following👇
An initial rate (test dose) of 30mg/kg/hour for 30 minute.
- If well tolerated, the rate of administration may be increased to 60mg/kg/hour for a further 30 minutes.
- Subsequent increases could be to 120mg/kg/hour and so on, up to the maximum approved rate.
- The maximum approved rate is 480mg/kg/hour.
Now in an obese individual weighing 120kg the total dose will be 240gm which is very high and damn costly. But that's not what is to be done.
This NHS information regarding IVIG dosing in obese individuals gives good guidance.
whittington.nhs.uk
In short follow this👇
🔥First calculate Ideal Body Weight of the individual
▫️Ideal body weight (IBW) (kg)
♂️IBW for males = 50 + (2.3 x (height in inches - 60))
♀️IBW for female = 45.5 + (2.3 x(height in inches - 60))
🔥Then calculate the Dose Determining Weight
▫️Dose determining weight (DDW) (kg):
DDW = IBW + 0.4 (actual bodyweight (kg) - IBW)
🔥Calculate the dose of IVIG to be given based on DDW.
DDW x 2g will be the total dose to be infused over 5 days.
Thanks for reading🙏
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#MedTwitter #MedEd #MedX
Intravenous Immunoglobulin - Dosing considerations in Guillain-Barré syndrome
First a question ❓️
A 120kg male diagnosed with Gullian Barre syndrome was planned to be given IVIG.
What is the total dose to be given ❓️
Is there an alternate dosing protocol in obese patients❓️
⭕️Intravenous Immunoglobulin and plasmapheresis are the main therapeutic interventions in management of GBS.
IVIG is costly and the dose in GBS is calculated as 400mg/day for 5 days or 2gm/kg total divided among 5 days.
Practically total dose is calculated as 2gm/ kg and then divided among 5 days.
IVIG comes in two concentrations in 🇮🇳
🔸️5% 100ml containing 5g
🔸️10% 100ml containing 10g
The main issue is that the dose is weight based and as weight increases the dose increases as does the cost !
Let's calculate the dosing in 73kg patient
Total dose = 73 x 2 = 146gm
Now it's divided among 5 days
Day 1 - 30
Day 2 - 30
Day 3 - 30
Day 4 - 30
Day 5 - 25
We approximate to the nearest 5 gm dose. Give maximum dose on first day. Give least on fifth day.
Infusion as following👇
An initial rate (test dose) of 30mg/kg/hour for 30 minute.
- If well tolerated, the rate of administration may be increased to 60mg/kg/hour for a further 30 minutes.
- Subsequent increases could be to 120mg/kg/hour and so on, up to the maximum approved rate.
- The maximum approved rate is 480mg/kg/hour.
Now in an obese individual weighing 120kg the total dose will be 240gm which is very high and damn costly. But that's not what is to be done.
This NHS information regarding IVIG dosing in obese individuals gives good guidance.
whittington.nhs.uk
In short follow this👇
🔥First calculate Ideal Body Weight of the individual
▫️Ideal body weight (IBW) (kg)
♂️IBW for males = 50 + (2.3 x (height in inches - 60))
♀️IBW for female = 45.5 + (2.3 x(height in inches - 60))
🔥Then calculate the Dose Determining Weight
▫️Dose determining weight (DDW) (kg):
DDW = IBW + 0.4 (actual bodyweight (kg) - IBW)
🔥Calculate the dose of IVIG to be given based on DDW.
DDW x 2g will be the total dose to be infused over 5 days.
Thanks for reading🙏
#MedTwitter #MedEd #MedicalStudentTwitter #IMGs #IMG #medicaleducation #MedStudentTwitter #medstudent #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #врачи #médecins #Medizin #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP
#MedTwitter #MedEd #MedX
Correction in original post (Typo)
It is 400mg/kg/day for 5 days
OR
2gm/kg divided over 5 days
It is 400mg/kg/day for 5 days
OR
2gm/kg divided over 5 days
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