Yes

Diuretic, Osmotic

Reduction of increased intracranial pressure associated with cerebral edema; promotion of diuresis in the prevention and/or treatment of oliguria or anuria due to acute renal failure; reduction of increased intraocular pressure; promoting urinary excretion of toxic substances; genitourinary irrigant in transurethral prostatic resection or other transurethral surgical procedures

C

Severe renal disease (anuria), dehydration, or active intracranial bleeding, severe pulmonary edema or congestion, hypersensitivity to any component

Should not be administered until adequacy of renal function and urine flow is established; cardiovascular status should also be evaluated; do not administer electrolyte-free mannitol solutions with blood

>10%:

Central nervous system: Headache

Gastrointestinal: Nausea, vomiting

Genitourinary: Polyuria

1% to 10%:

Central nervous system: Dizziness

Dermatologic: Rash

Ocular: Blurred vision

<1%: Circulatory overload, congestive heart failure, convulsions, headache, chills, fluid and electrolyte imbalance, water intoxication, dehydration and hypovolemia secondary to rapid diuresis, xerostomia, dysuria, tissue necrosis, pulmonary edema, allergic reactions

Symptoms of overdose include polyuria, hypotension, cardiovascular collapse, pulmonary edema, hyponatremia, hypokalemia, oliguria, seizures

Increased electrolyte excretion and fluid overload can occur; hemodialysis will clear mannitol and reduce osmolality

Lithium toxicity (with diuretic-induced hyponatremia)

Should be stored at room temperature (15°C to 30°C) and protected from freezing; crystallization may occur at low temperatures; do not use solutions that contain crystals, heating in a hot water bath and vigorous shaking may be utilized for resolubilization; cool solutions to body temperature before using

Increases the osmotic pressure of glomerular filtrate, which inhibits tubular reabsorption of water and electrolytes and increases urinary output

Onset of diuresis: Injection: Within 1-3 hours

Onset of reduction in intracerebral pressure: Within 15 minutes

Duration of reduction in intracerebral pressure: 3-6 hours

Distribution: Remains confined to extracellular space (except in extreme concentrations) and does not penetrate the blood-brain barrier

Metabolism: Minimal amounts metabolized in the liver to glycogen

Half-life: 1.1-1.6 hours

Elimination: Primarily excreted unchanged in urine by glomerular filtration

I.V.:

Test dose (to assess adequate renal function): 200 mg/kg over 3-5 minutes to produce a urine flow of at least 1 mL/kg for 1-3 hours

Initial: 0.5-1 g/kg

Maintenance: 0.25-0.5 g/kg given every 4-6 hours

Adults:

Test dose (to assess adequate renal function): 12.5 g (200 mg/kg) over 3-5 minutes to produce a urine flow of at least 30-50 mL of urine per hour over the next 2-3 hours

Initial: 0.5-1 g/kg

Maintenance: 0.25-0.5 g/kg every 4-6 hours; usual adult dose: 20-200 g/24 hours

Intracranial pressure: Cerebral edema: 1.5-2 g/kg/dose I.V. as a 15% to 20% solution over greater than or equal to 30 minutes; maintain serum osmolality 310-320 mOsm/kg

Preoperative for neurosurgery: 1.5-2 g/kg administered 1-1.5 hours prior to surgery

Transurethral irrigation: Use urogenital solution as required for irrigation

Renal function, daily fluid I & O, serum electrolytes, serum and urine osmolality; for treatment of elevated intracranial pressure, maintain serum osmolality 310-320 mOsm/kg

May cause dizziness

Has been used to treat lithium toxicity/overdose but its overall effect in lowering serum lithium level is minimum; if toxicity is severe, hemodialysis is the treatment of choice

This medication can only be given by infusion. Report immediately any muscle weakness, numbness, tingling, acute headache, nausea, dizziness, blurred vision, eye pain, difficulty breathing, chest pain, or pain at infusion site. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Consult prescriber if breast-feeding.

Avoid extravasation; crenation and agglutination of red blood cells may occur if administered with whole blood

Injection: 5% [50 mg/mL] (1000 mL); 10% [100 mg/mL] (500 mL, 1000 mL); 15% [150 mg/mL] (150 mL, 500 mL); 20% [200 mg/mL] (150 mL, 250 mL, 500 mL); 25% [250 mg/mL] (50 mL)

Solution, urogenital: 0.54% [5.4 mg/mL] (2000 mL)

Gadallah MF, Lynn M, and Work J, "Case Report: Mannitol Nephrotoxicity Syndrome: Role of Hemodialysis and Postulate of Mechanisms," Am J Med Sci, 1995, 309(4):219-22.

Goodwin WE and Latta H, "Focal Osmotic Nephrosis Due to Therapeutic Use of Mannitol: A Case of Perirenal Hematoma After Renal Biopsy," J Urol, 1970, 103(1):11-4.

Huff JS, "Acute Mannitol Intoxication in a Patient With Normal Renal Function," Am J Emerg Med, 1990, 8(4):338-9.

Moses FM, "Colonic Perforation Due to Oral Mannitol," JAMA, 1988, 260(5):640.

Palmquist KL, Quattrocchi FP, and Looney LA, "Compatibility of Furosemide With 20% Mannitol," Am J Health Syst Pharm, 1995, 52(6):648,50.

Shapiro WR and Shapiro JR, "Principles of Brain Tumor Chemotherapy," Semin Oncol, 1986, 13(1):56-69.