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Mannitol

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Mannitol

  • Indications
  1. Acute Severe Intracranial Pressure Management (cereral edema with Brainstem Herniation)
  2. Narrow Angle Glaucoma
  • Contraindications
  1. Congestive Heart Failure (transient increase in CVP)
  2. Hypertension
  3. Pulmonary Edema
  • Mechanism
  1. Mannitol is a sugar Alcohol found naturally in fruits and vegetables
    1. Six-carbon sugar Alcohol
    2. Formed from reduction of mannose or fructose
  2. Mannitol acts as an osmotic Diuretic
    1. Freely filtered by glomerulus, but poorly reabsorbed at renal tubule
    2. Increases osmolarity of glomerular fluid, resulting in diuresis (water, Sodium, chloride)
  3. Increases plasma osmolarity
    1. Draws water from cells into plasma and interstitial fluid
    2. Transiently reduces tissue edema and increases plasma volume and Blood Pressure
      1. Later, fluid and Electrolyte redistribution results in Hypotension and Electrolyte abnormalities
  • Adverse Effects
  1. Headache
  2. Nausea
  3. Vomiting
  4. Lethargy
  5. Dizziness
  • Precautions
  1. Filter solutions with concentration >20% (due to risk of crystallization)
  2. Monitor serum electolytes (e.g. basic chemistry panel) and fluid status
  • Dosing
  1. Available as solution concentrations: 15% , 20% , 25%
  2. Intracranial Hypertension
    1. Dose: 0.25 to 1 g/kg IV over 20 minutes every 4-6 hours as needed
    2. Single dose of 1-2 g IV may be given over 30-60 minutes
  • Resources
  1. Mannitol Injection Solution
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8ad3145e-00e7-4412-b9a5-06f00f264f30
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster, Miami, p. 62-3
  2. Hamilton (2010) Tarason Pocket Pharmacopeia, p. 224