- Mannitol is an Osmotic diuretic
- 6 carbon sugar
- Dose: 0.25-1.0 g/kg
- Filtered at the glomerulus, but does not get significant reabsorption in the proximal tubule. This osmotically prevents passive water reabsorption that would occur with the active Na+ reabsorption in the proximal tubule
- Rapidly acting, therefore this acutely raises plasma/extracellular osmolarity
- Leads to hyperosmolality, hyponatremia, hypokalemia.
- Prophylaxis against ARF in high risk patients (rhabdomyolysis, massive trauma, hemolytic reactions, severe jaundice, cardiac/major vascular surgery)
- Transplant surgery
- Acute reduction of intraocular pressure
- Acute reduction of intracranial pressure/cerebral edema
- Forced diuresis to remove toxic substances (acute drug overdose)
- Causes a transient and rapid intracellular to extracellular water shift
- This can cause fluid overload leading to CHF and pulmonary edema
- Transient hyponatremia
- Mild/moderate transient increase in plasma potassium
- Be careful giving large boluses too rapidly. May be advisable to give large bolus in divided doses over ½ hour or longer.