Where the Kidney is Concerned, How Much Mannitol is Too Much?

Rabetoy, Gary M.; Fredericks, Michael; Hostettler, Charles

doi:10.1177/106002809302700105

Cited by 39 publications

(21 citation statements)

References 18 publications

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“…This amount is four times the maximum dose recommended in humans, and the practical uselessness of administering higher doses to reduce intracranial pressure has been proven. Higher or similar infusion rates, according to infusion time and patients' weight, can be calculated in other cases (0.26 and 0.41 g/kg/h) [2,3]. In other reports [4][5][6], even without weight data, a similar administered amount can be established unless the weights were higher than 80 kg.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure following Massive Mannitol Infusion

Pérez-Pérez¹,

Pazos²,

Sobrado³

et al. 2002

Am J Nephrol

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Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 ± 439 g (mean ± SD) during a time period of 58 ± 28 h. The infusion rate was 0.25 ± 0.02 g/kg/h. The onset of acute renal failure was detected 48 ± 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 ± 11 mEq/l), and hyperosmolality (osmolar gap 70 ± 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension – one of them while recovering – on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.

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Section: Discussionmentioning

confidence: 99%

Acute Renal Failure following Massive Mannitol Infusion

Pérez-Pérez¹,

Pazos²,

Sobrado³

et al. 2002

Am J Nephrol

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“…1,2,5,9,10 Discontinuance of mannitol has been mentioned as the primary mode of therapy in majority of reports. 11,17,26,[29][30][31][32][33][34][35][36][37] Eleven reports/series mentioned the use of dialysis with or without ultrafiltration in addition (Tsai et Table 2). Total recovery without dialysis specifically was narrated by two reports/series (Docci et al and Visweswaran et al).…”

Section: Resultsmentioning

confidence: 99%

Osmotic nephrosis with mannitol: review article

et al. 2014

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Mannitol is commonly used to lower intracranial and intraocular pressures. Large doses/massive infusions of mannitol have been found to be associated with acute renal failure (MI-ARF), that is, osmotic nephrosis. While many researchers have reported individual experiences with this pathology, we felt that there is need of an updated comprehensive review of all reported cases with elaboration of etiology, pathogenesis, diagnosis and management plan for MI-ARF. The purpose of the present communication is to share our own experience with MI-ARF, to review the effect of mannitol on kidney function and to highlight the dynamics of MI-ARF with considerations for the cautious use of mannitol in patients with risk factors for kidney diseases. KeywordsAcute renal failure/injury, mannitol, osmotic nephrosis, mannitol-induced acute renal failure, mannitol-induced osmotic nephrosis History

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“…Hemodialysis can speed up the elimination of mannitol from extracellular space in patients with "osmotic nephrosis" induced by mannitol and reduce the course of AKI. 3,17,21,[24][25][26][27][28] Few previous studies about the risk factors of AKI after cerebral trauma focused on mannitol, not to speak of verifying the relationship between mannitol and AKI. Our study demonstrated that mannitol was an independent risk factor of AKI after cerebral trauma, which was positively correlated to accumulative doses of mannitol.…”

Section: Discussionmentioning

confidence: 99%

Mannitol is an independent risk factor of acute kidney injury after cerebral trauma: a case–control study

You

Chen

et al. 2010

Renal Failure

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We retrospectively studied a random cohort of patients with cerebral trauma to investigate the risk factors of acute kidney injury (AKI) following cerebral trauma. AKI was determined using the RIFLE (risk, injury, failure, loss, or end-stage kidney) staging criteria. About 171 patients were chosen in the study, with 53 patients in AKI group and 118 patients without AKI in non-AKI group. By logistic regression analysis, univariate analysis revealed that age, hypertension, emergent surgery, systemic inflammatory response syndrome (SIRS), Glasgow coma score (GCS), sequential organ failure assessment (SOFA) score, the respiration, coagulation, and cardiovascular components of the SOFA score, mechanical ventilation time, red blood cell transfusion, plasma transfusion, and the accumulative doses of furosemide, torsemide, and mannitol were significantly related to AKI after cerebral trauma. Logistic multivariate regression analysis showed that SOFA score [odds ratio (OR) = 1.516, 95% confidence interval (CI) 1.222-1.881, p < 0.001], the accumulative doses of torsemide (OR = 0.016, 95% CI 1.002-1.031, p = 0.016), and the accumulative doses of mannitol (OR = 2.687, 95% CI 1.062-6.800, p = 0.037) were independent risk factors of AKI. This model had a good discrimination for AKI with an area under the receiver operating characteristic (ROC) curve of 0.901 (p < 0.001). The accumulative doses of mannitol as a risk factor of AKI were identified by propensity score match (PSM) method. We concluded that AKI was a common complication in patients with cerebral trauma. SOFA score and the accumulative doses of torsemide and mannitol were independent risk factors of AKI following cerebral trauma.

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Where the Kidney is Concerned, How Much Mannitol is Too Much?

Abstract: It is likely that sufficient doses of mannitol may lead to ARF. Limitation of dose may prevent and treatment with hemodialysis may reverse ARF in these instances.

Cited by 39 publications

References 18 publications

Acute Renal Failure following Massive Mannitol Infusion

Acute Renal Failure following Massive Mannitol Infusion

Osmotic nephrosis with mannitol: review article

Mannitol is an independent risk factor of acute kidney injury after cerebral trauma: a case–control study

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