Mannitol

Brand Name: Osmitrol, Resectisol

Classification: Osmotic Diuretic

Action Summary

Half-life	Onset	Peak	Duration
100 minutes	30-60 minutes	1 hour	6-8 hours

Indications

1. Acute oliguric renal failure
2. Toxic overdose
3. Edema
4. Increased intracranial pressure (ICP)
5. Intraocular pressure (IOP)

Action

1. In the oliguric phase of acute renal failure, Mannitol increases osmotic pressure (pressure needed to stop the absorption of something or osmosis) of the glumerular filtrate, thereby,promoting diuresis (treating the oliguric phase of renal failure) and excretes toxic materials (management for toxic overdose).
2. It also elevates blood plasma osmolality thus, inhibiting the reabsorption of water and electrolytes (for relief of edema) and mobilizing fluids in the cerebral and ocular spaces(lowers intracranial or intraocular pressure).

Contraindications

1. Susceptibility
2. Dehydration

Adverse reactions

1. Dehydration
2. Anuria
3. Intracranial bleeding
4. Headache
5. Blurred vision
6. Nausea and vomiting
7. Volume expansion
8. Chest pain
9. Pulmonary edema
10. Thirst
11. Tachycardia
12. Hypokalemia (increases the risk of digoxin toxicity)
13. Chronic renal failure

Dosage

Adult

Oliguria: 50-100 g as a 5-25% solution.

Intracranial/Intraocular pressure: 0.25-2 g/kg as 15-25% solution administered for 30-60 minutes.

Children

Oliguria: 0.25-2 g/kg as a 15-20% solution for 2-6 hours

Intracranial/Intraocular pressure: 1-2 g/kg as a 15-20% solution administered for 30-60 minutes.

Nursing considerations

Assessment – Monitor the following:

1. 1. Vital signs
2. 2. Intake and output
3. 3. Central venous pressure
4. Pulmonary artery pressure
5. Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst)
6. Sign of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness, confusion, tingling sensation of extremity and excessive thirst)
7. (for increase ICP) Neurologic status and intracranial pressure readings.
8. (for increase IOP) Elevating eye pain or decreased visual acuity.

Laboratory Tests

1. Renal function (BUN and Creatinine)
2. Serum Electrolyte (Sodium and Potassium)

Precaution

Pregnancy and lactation (safe use during these conditions is not established)

Interventions

1. Observe the IV site regularly for infiltration.
2. Administration rate for oliguria should be titrated to produce a urine output. (about 30-50 ml/hr in adult and 2-6 hours in children)

image from mannitol.org