[CIS PIDD] [cis-pidd] Nausea with IVIG infusions

[Soheil Chegini]

Hello,
Osmotic shift is the the probable culprit, which might be less pronounced with lower osmolar solutions such as Gammagard or gammunex. Reducing the infusion rate and co-infusion of LR at the same rate piggy-backed with IVIG may eliminate this patient's trouble. I would also suggest considering premedication with Compazine that is used in treatment of both headache and nausea associated with migraine, and might be an appropriate alternative. It can cause sedation, but may be well tolerated, especially if she has not complained of sedation with Phenergan and Benadryl. Dystonia is a rare but scary side effect that resolves rapidly with Benadryl, if it is experienced. Emend is a new, fairly effective antiemetic, which acts on NK1 receptors as an antagonist and is used in nausea caused by chemotherapy or post-OP. It is rather expensive, but it could be considered if all else fails.
Good luck,

Soheil Chegini, M.D.
Exton Allergy & Asthma Associates
656 West Lincoln Hwy.
Exton, PA 19341
Phone: (610) 269-3066
Fax: (610) 269-8615



________________________________
 From: "Church, Joseph" <JChurch at chla.usc.edu>
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org> 
Sent: Friday, January 25, 2013 7:26 PM
Subject: [cis-pidd] Nausea with IVIG infusions
 

 
Colleagues:
 
I follow a young adult woman with CVID who has had multiple problems, originally severe headaches, with Ig infusions.  We have tried SCIG (hated), IVIG q4 and q2weeks, premedications with iv diphenhydramine and motrin.  
 
Most recently she has done better with regards to headache on a q week schedule with pre-Ig hydration, motrin and iv diphenhydramine, and Maxault prn
 
Now her complaint is nausea that she states starts soon after the IVIG begins infusing and worsens over the next 12-24 hours despite use of Phenergan (not my Rx) and Zofran.
 
Any thoughts?  
 
Thanks in advance.
 
Joe Church
Children's Hospital Los Angeles
 
 

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