- 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.