MANNITOL
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)
mannitol __g IV Q __ H (__mg/kg/dose)
mannitol __g IV prior to and with cisplatin (__g/m2/dose)
Dosages
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.
Mannitol diuresis with cisplatin:
0.5 gram/kg IV PRN for inadequate urine output per protocol
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
0.5 gram/kg IV PRN for inadequate urine output per protocol
Mechanism of Action
Osmotic diuretic
Forms Supplied
injection:
25% - 50 mL vial
20% - 500 mL IV bag
20% mannitol contains 20 g in 100 mL = 200 mg/1 mL
Comments
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).
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).
References
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
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 Edited
2022-04-08 03:52:03