Mannitol

General

• Type: sugar alcohol, derived from mannose, stereo-isomer of sorbitol
• Dosage Forms: Reconstituted powder and solution
  • 5% and 10% in 1000ml containers
  • 15% in 500ml containers
  • 20% in 250ml and 500ml containers
  • 25% in 50ml flip-top vials
• Common Trade Names: Mannitol, Osmitrol

Dosing

Adult

Elevated intracranial pressure

• 0.25-2 g/kg given every 6 to 8 hours
  • Should be given as a one time bolus (may be inferior to Hypertonic Saline)
  • Easy ED dosing: 1g/kg bolus in ED (while awaiting neurosurgery eval/admission)

Pediatric Dosing

Cerebral edema

• 0.25-1 g/kg IV initially; maintenance dose of 0.25-0.5 g/kg IV q4-6hr

Special Populations

• Pregnancy Rating: C
• Lactation:
  • Unknown if present in breast milk
• Renal Dosing
  • Adult
    • Contraindicated in severe renal impairment
  • Pediatric
    • Contraindicated in severe renal impairment
• Hepatic Dosing
  • Adult
    • No adjustment necessary
  • Pediatric
    • No adjustment necessary

Indications

• Lowering ICP with signs of impending herniation or severely deteriorating mental status in context of known trauma or intracranial lesion exerting mass effect

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Heart failure
• Worsening dehydration
• Hyponatremia
• Hypokalemia
• Hypocalcemia

Common

• Cough
• Sore throat
• Dry mouth
• Headache
• Nausea

Pharmacology

• Onset of action: 5-10 minutes
• Half-life: 6 hours
• Metabolism:
• Excretion: Urine
• Mechanism of Action: Increased tonicity of mannitol draws water out of the brain parenchyma and into the intravascular space

References

• Mannitol (systemic): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.