Mannitol (Osmitrol, Resectisol)

Category:

• Diuretic

Description:

• Osmolar diuretic

Indications:

• Reduction of intracranial pressure associated with cerebral edema

• Reduction of intraocular pressure

• Improve renal function in oliguric phase of acute renal failure

• Promote urinary excretion of toxic substances

Contraindications:

• Active intracranial bleeding

• Anuria; severe pulmonary congestion or edema; severe dehydration  

Precautions:

• Pregnancy category C

• Monitor serum electrolytes, urine output  

Adverse Reactions (Side Effects):

• CNS: confusion, dizziness, seizures, headache, rebound increased intracranial pressure

• CV: angina-like chest pain, CHF, edema, hypertension, hypotension, tachycardia, thrombophlebitis

• EENT: blurred vision, loss of hearing, nasal congestion

• GU: osmotic necrosis, urinary retention

• METAB: acidosis, dehydration, electrolyte loss, fluid and electrolyte imbalances

• SKIN: skin necrosis, urticaria

• MISC: chills, fever  

Dosage:

Administered intravenously

• Adult: Oliguria prevention: 

  • IV 50-100 grams of 5%-25% solution

  • Oliguria treatment: 

    • IV 50-100 grams of 15%-20% solution

  • Intraocular pressure, intracranial pressure: 

    • IV 1.5-2 g/kg of 15%-25% solution over 30-60 minutes

  • Diuresis in drug intoxication: 

    • IV 5%-10% solution continuously up to 200 grams while maintaining urine output of 100-500 ml/hr

  • Urologic irrigation: 

    • Add contents of two 50ml vials of 25% mannitol to 900ml sterile water for injection and use as irrigation

• Child: 

  • IV 0.5-1 g/kg initially,k then 0.25-0.5 g/kg every 4-6 hours for maintenance