Mannitol is an osmotic diuretic.
Release form and composition
Mannitol is produced in the form of an infusion solution (200 and 400 ml each in glass bottles of 250 and 450 ml, respectively, in a cardboard pack 1 bottle; in corrugated cardboard boxes 24 bottles of 200 ml or 12 bottles 400 for hospitals).
1 liter of solution contains:
- Active ingredient: mannitol - 150 g;
- Auxiliary components: sodium chloride and water for injection.
Ionic composition of 1 liter of solution:
- Mannitol - 823 mmol / l;
- Na + - 154 mmol / l;
- Cl - - 154 mmol / l.
The theoretical osmolarity of the drug is 1131 mosmol / l.
Indications for use
Mannitol is used in the treatment of the following diseases:
- Intracranial hypertension (with renal or renal-hepatic failure);
- Swelling of the brain;
- Post-transfusion complications resulting from the introduction of incompatible blood;
- Oliguria due to acute renal or renal-hepatic failure, provided that the renal filtration capacity is preserved (as part of a combination therapy);
- Poisoning with salicylates and barbiturates (for forced diuresis).
In addition, the drug is prescribed for the prevention of hemolysis in surgical interventions with the use of extracorporeal circulation to prevent renal ischemia and associated acute renal failure.
- Hemorrhagic stroke;
- Chronic heart failure;
- Subarachnoid hemorrhage (with the exception of bleeding during craniotomy);
- Left ventricular failure (especially if it is accompanied by pulmonary edema);
- Severe dehydration;
- Anuria due to acute tubular necrosis in severe kidney damage;
- Hypersensitivity to the drug.
With extreme caution should be the treatment of the elderly, pregnant and lactating women.
Dosing and Administration
Mannitol is intended for intravenous administration - slow jet or drip.
In order to prevent the drug prescribed in a dose of 0.5 g / kg patient weight, for medicinal purposes - in a dose of 1-1.5 g / kg. The maximum allowable daily dose - 180 g
When performing an operation with artificial blood circulation, the solution is injected in a dose of 20-40 g into the apparatus immediately before the start of perfusion.
For oliguria, it is recommended to pre-administer a test dose - 0.2 g intravenously over 3-5 minutes. If within 2-3 hours after this the diuresis rate will not increase to 30-50 ml / hour, the further use of the drug is impractical.
Before the introduction of the solution is heated to a temperature of 37 ºC.
During the period of Mannitol treatment, there is a likelihood of dehydration (manifested by symptoms such as dry skin, thirst, dry mouth, myasthenia, dyspepsia, low blood pressure, hallucinations, convulsions) and impaired water-electrolyte metabolism (manifested by an increase in circulating blood and / or hyponatremia, rarely - hyperkalemia).
In some cases, there is pain in the chest, tachycardia, skin rash, thrombophlebitis.
With left ventricular failure there is a risk of pulmonary edema, therefore Mannitol should be combined with fast-acting loop diuretics, and the treatment should be carried out under the control of diuresis, blood pressure and electrolyte concentration in the blood serum (potassium ions, sodium).
If a headache, dizziness, blurred vision and / or vomiting occurs when the drug is injected, the infusion should be stopped and examined to exclude subarachnoid and subdural bleeding.
Mannitol can be used for heart failure (only simultaneously with loop diuretics), as well as hypertensive crisis with encephalopathy.
Repeated infusion should be carried out under the control of indicators of water and electrolyte balance of blood.
If the solution is stored at a temperature below 20 ºC, its crystallization is possible. Before use, the bottle should be heated to a temperature of 50-70 ºC in order for the sediment to dissolve. But to use such a drug is possible only after cooling to body temperature and provided that the crystals do not fall out again.
With the simultaneous use of mannitol can enhance the toxic effect of cardiac glycosides.
Terms and conditions of storage
Store at a temperature of 18-25 ºС out of reach of children.
Shelf life - 2 years.