Mannitol 20%

Indications

Mannitol 20% is used for: Chronic bronchitis, Cerebral oedema, Oliguric phase of renal failure, Raised intracranial pressure, Renal function testing, Transurethral prostatic resection

Adult Dose

Intravenous Oliguric phase of renal failure Adult: 50-100 g in a 24-hr period by IV infusion. Adjust rate of administration to maintain a urine flow of at least 30-50 mL/hr. Cerebral oedema, Reduction of raised intraocular pressure Adult: 0.25-2 g/kg by IV infusion given over 30-60 minutes. Renal function testing Adult: 0.2 g/kg infused over 3-5 min.

Child Dose

Intravenous Edema 0.25-1 g/kg IV initially; maintenance dose of 0.25-0.5 g/kg IV q4-6hr Anuria/Oliguria Test dose: 0.2 g/kg IV over 3-5 minutes; not to exceed 12.5 g Discontinue if no diuresis within 2 hr

Renal Dose

Administration

Contra Indications

Pulmonary congestion or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration.

Precautions

Hypervolaemia; urinary tract obstruction; check for signs of fluid and electrolyte imbalance. Should not be administered with whole blood. Pregnancy, lactation.

Pregnancy-Lactation

Pregnancy Available case report data over decades of use have not identified drug- associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Drug crosses placenta and may cause fluid shifts that could potentially result in adverse effects in fetus; product should be given to pregnant woman only if clearly needed Labor and delivery Studies have not been conducted to evaluate effects on labor and delivery; exercise caution when administering product during labor and delivery Animal data No adverse developmental effects from mannitol reported in published animal studies; however, fluid shifts occurred in fetal ewes in response to maternal infusion of drug Lactation There are no data on presence of mannitol in either human or animal milk, effects on breastfed infant, or on milk production Consider developmental and health benefits of breastfeeding along with mother’s clinical need for drug and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

Interactions

Increased nephrotoxicity with ciclosporin.

Adverse Effects

Side effects of Mannitol 20% : Fluid and electrolyte imbalance; acidosis (with high doses). Nausea, vomiting, thirst; headache, dizziness, convulsions, chills, fever; tachycardia, chest pain; blurred vision; urticaria and hypotension or hypertension; acute renal failure; skin necrosis; thrombophloebitis.

Mechanism of Action

Mannitol increases urinary output by inhibiting tubular reabsorption of water and electrolytes. It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues.