Hypotension immunoglobulin

The resuspended and formulated Fraction II precipitate normally contains some aggregated IgG and trace substances that can cause hypotensive reactions in patients, such as the enzyme prekail ikrein activator (186). These features restrict this type of product to intramuscular adininistration. Further processing is required if products suitable for intravenous adininistration are required. Processes used for this purpose include treatment at pH 4 with the enzyme pepsin [9001-75-6] being added if necessary (131,184), or further purification by ion-exchange chromatography (44). These and other methods have been fiiUy reviewed (45,185,187,188). Intravenous immunoglobulin products are usually suppHed in the freeze-dried state but a product stable in the solution state is also available (189). 

For acute symptomatic hypocalcemia, 200 to 300 mg of elemental calcium is administered IV and repeated until symptoms are fully controlled. This is achieved by infusing 1 g of calcium chloride or 2 to 3 grams of calcium at a rate no faster than 30 to 60 mg of elemental calcium per minute. More rapid administration is associated with hypotension, bradycardia, or cardiac asystole. Total calcium concentration is commonly monitored in critically ill patients. Under normal circumstances, about half of calcium is loosely bound to serum proteins while the other half is free. Total calcium concentration measures bound and free calcium. Ionized calcium measures free calcium only. Under usual circumstances, a normal calcium level implies a normal free ionized calcium level. Ionized calcium should be obtained in patients with comorbid conditions that would lead to inconsistency between total calcium and free serum calcium (abnormal albumin, protein, or immunoglobulin concentrations). For chronic asymptomatic hypocalcemia, oral calcium supplements are given at doses of 2 to 4 g/day of elemental calcium. Many patients with calcium deficiency have concurrent vitamin D deficiency that must also be corrected in order to restore calcium homeostasis.2,37,38... 

Infusion of intravenous immunoglobulin 0.14 g/kg in 17 patients with autoimmune diseases, in whom circulating immunoglobulins had been depleted, was associated with a high incidence of serious adverse effects (94). Treatment was terminated in four patients because of adverse effects, including urticaria, severe hypotension, arthralgia, and chest discomfort. 

Chidwick K, Matejtschuk P, Gascoigne E, Briggs N, More JE, Dash CH. Clinical experience with a new solvent detergent-treated intravenous immunoglobulin free of hypotensive effects. Vox Sang 1999 77(4) 204-9. 

Osmotic nephrosis When the proximal tubules are exposed to hyper osmotic, non-reabsorbable solutes such as mannitol, osmotic nephrosis can lead to AKI. [69]. More recently the use of hy-droxyethylstarch for resuscitation of hypotensive patients has been associated with increased incidence of AKI [70] The addition of sugar excipients to Intravenous immunoglobulin s, while reducing the constitutional symptoms associated with their administration have increased in the risk of acute kidney injury [71]. 

Cardiovascular Hypotension, hypertension, chest pain, and rarely dysrhythmias or myocardial infarction have been associated with the use of intravenous immunoglobulin [1, 53, 54, 55", 57"]. In a small crossover study in patients with multifocal motor neuropathy there was one case of phlebitis... 

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