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- Discussion:
    - for reduction of intracranial or intraocular pressure;
    - for osmotic diuresis, cerebral edema, ?oliguria, ?anuria, ?myoglobinuria;
    - serves as rapid volumeexpander;
    - adult: test dose:
            - 0.2gm/kg/dose IV over 3-5 min;
            - if no diuresis in 2 hr d/c;
    - cerebral edema:
            - try: 25gm (100ml of 20% solution) given over 15-30min;
            - may repeat q2-3hr prn;
            - 0.25gm/kg/dose IV push repeated at 5 min intervals prn;
            - max dose: 1gm/kg/dose prn intracranial HTN;
    - precautions:
            - CHF, volume overload;
    - peds:
            - test dose: of 0.75 gm/kg/dose IV over 3-5 min; if no diuresis within 2 hr, d/c;
            - cerebral edema: same as adult:

- Protocol for Reperfusion: (reperfusion injury)
    - once hemodynamically stable, and urine flow has been confirmed, forced mannitol-alkaline diuresis (see bicarbonate)
             for prophylaxis against hyperkalemia and acute renal failure should be undertaken;
    - consider use of sodium bicarbonate - NaCl  Solution (bicarbonate 40 mmol per liter) in D5W to which approx 10 gm of
             mannitol / liter is added in 20 % solution;
    - this is infused at rate of approx 12 liters / day, forcing a diuresis of approximately 8 liters per day and maintaining
             urinary pH above 6.5, until myoglobinuria disappears (usually by the third day);
    - infusion of bicarbonate may be gradually discontinued after 36 hours.

Pulmonary edema after aneurysm surgery is modified by mannitol.

Combined mannitol and deferoxamine therapy for myohemoglobinuric renal injury and oxidant tubular stress. Mechanistic and therapeutic implications.

The influence of mannitol on myoglobinuric acute renal failure: functional, biochemical, and morphological assessments.

The effects of the perfusion of various solutions on the no-reflow phenomenon in experimental free flaps.