DRUG SUPPLIED DOSE COMMENTS
MANNITOL (Paeds)


Mechanism of action:

Osmotic diuretic



Ref:
544

1.    RCT of 20% mannitol vs 3% hypertonic saline in children with raised ICP due to acute CNS infections (Pediatric and Critical Care Medicine 21(12), 2020
2.    Comparative assessment of hypertonic saline vs mannitol in the treatment of intracranial hypertension in children (Eur J Mol & Clin Med, 2020 7(10)
3.    Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic review and meta-analysis (Medicine 2020 99(35): e21655




Last update: 2022-04-08
injection: 
25% - 50 mL vial
20% - 500 mL IV bag

20% mannitol contains 20 g in 100 mL = 200 mg/1 mL

 Anuria/Oliguria:
Test Dose: (to assess renal function)
 0.2 g/kg/dose IV (maximum 12.5 g/dose over 3-5 min.  D/C if no diuresis within 2 hr.
Initial:  0.5-1 g/kg/dose IV over 2-6 hrs
Maintenance:  0.25-0.5 g/kg/dose IV Q4-6H.

Cerebral edema (increased ICP):
0.25-1 g/kg (1.25-5 mL/kg of 20%) IV over 20-30 min (may be given over 3-5 min in critical care) min.  Repeat Q4-8H PRN

Mannitol diuresis with cisplatin:
0.5 gram/kg IV PRN for inadequate urine output per protocol

 If serum sodium is less than 140 mmol/L, 3% NaCl   should be used for management of ICP.  If serum sodium is greater than 140 mmol/L, 3% NaCl or mannitol could be considered for management.

Evidence suggest 3% NaCl may be the preferred treatment for increased ICP due to multisystem trauma and cerebral edema from DKA.

Risk of fluid and electrolye imbalances, hyperosomolality and dehydration.

Ensure patient is well-hydrated before use.

Rapid infusions can cause hypotension.

Insert Foley catheter prior to mannitol (if treating increased ICP).

Crystal formation in vials may be dissolved in hot water bath.

Use a 5 micron in-line filter for solutions >20% (200 mg/mL).



Standard Prescription:

mannitol __g IV x 1 dose over 3 to 5 min (__mg/kg/dose)

mannitol __g IV Q __ H (__mg/kg/dose)

mannitol __g IV prior to and with cisplatin (__g/m2/dose)