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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Rapid therapies for myasthenia gravis[1-3]

Rapid therapies for myasthenia gravis[1-3]
  Plasmapheresis Intravenous immune globulin (IVIG)
Usual adult dose 5 exchange treatments of 3 to 5 liters with 5% albumin over 7 to 14 days

2 g/kg in evenly divided doses over 2 to 5 days

Examples: 400 mg/kg daily for 5 days or 1 g/kg on 2 consecutive days*[1]
Onset of effect 1 to 7 days 1 to 2 weeks
Maximal effect 1 to 3 weeks 1 to 3 weeks
Adverse effects Line infection, hypotension, thromboembolism, bleeding, adverse reaction(s) to citrate anticoagulant added during procedure (hypocalcemia, metabolic alkalosis)

Rate-related reactions (common): headache, chills, flushing, low backache, nausea, tachycardia, dyspnea

Delayed reactions (rare): thromboembolism, kidney failure, hematologic complications (hemolysis, neutropenia)

Other (rare): transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), hypersensitivity (eg, anaphylaxis)
UpToDate authors generally use plasma exchange as a first-line therapy for myasthenic crisis, in part because the onset of action seems to be more rapid. For additional information on adverse effects of plasmapheresis and IVIG, refer to UpToDate clinical topics on therapeutic apheresis and IVIG.
* Dividing dose over more days (eg, 5 days) may be better tolerated in patients with kidney disease or heart failure, or in older adults. For dosing in patients with obesity, some UpToDate contributors recommend starting with a dose based on ideal body weight or adjusted body weight and modifying based on clinical response. A calculator to determine ideal body weight and adjusted body weight is available in UpToDate.
References:
  1. Sussman J, Farrugia ME, Maddison P, et al. Myasthenia gravis: Association of British Neurologists' management guidelines. Pract Neurol 2015; 15:199.
  2. Barth D, Nabavi Nouri M, Ng E, et al. Comparison of IVIg and PLEX in patients with myasthenia gravis. Neurology 2011; 76:2017.
  3. Ebadi H, Barth D, Bril V. Safety of plasma exchange therapy in patients with myasthenia gravis. Muscle Nerve 2013; 47:510.
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