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