Mannitol

Mannitol is an osmotic diuretic.

Release form and composition

Mannitol is available in the form of a 15% solution for infusion: clear, colorless (200 and 400 ml each in glass bottles for blood and blood substitutes, sealed with rubber stoppers and crimped with aluminum caps).

100 ml of solution contains:

• Active ingredient: mannitol - 15 g;
• Auxiliary components: sodium chloride and injectable water.

Indications for use

Mannitol is used to treat the following diseases:

• Cranial hypertension in patients with renal or renal-hepatic insufficiency;
• Status epilepticus;
• Acute glaucoma attack;
• Swelling of the brain;
• Post-transfusion complications in patients who received incompatible blood;
• Oliguria in patients with acute renal or renal-hepatic failure, but preserved renal filtration capacity (as part of complex therapy).

For forced diuresis, mannitol is used in cases of poisoning with barbiturates or salicylates.

In addition, the drug is prescribed for the prevention of hemolysis during surgery with extracorporeal circulation to prevent renal ischemia and associated acute renal failure.

Contraindications

• Hypochloremia;
• Hypokalemia;
• Hyponatremia;
• Chronic heart failure;
• Pulmonary edema due to acute left ventricular failure;
• Subarachnoid hemorrhage (with the exception of bleeding that occurred when performing craniotomy);
• Severe forms of dehydration;
• Hemorrhagic stroke;
• Anuria due to acute necrosis of the tubules with severe kidney damage.

Mannitol should be used with caution during pregnancy and lactation.

Dosing and Administration

The drug is administered intravenously - drip or slowly jet.

Recommended doses: prophylactic - 0.5 mg per kilogram of the patient's body weight, therapeutic - 1-1.5 g / kg. The maximum daily dose - 180 g

When performing surgical operations with extracorporeal circulation immediately before the start of perfusion, 20-40 g of mannitol are introduced into the device.

Patients with oliguria before the appointment of a full dose is recommended to test: 0.2 solution drip in for 3-5 minutes. If after 2-3 hours there is no increase in the rate of diuresis to 30-50 ml / hour, further administration of the drug is contraindicated.

Side effects

Possible side effects caused by mannitol:

• Dehydration, manifested by symptoms such as dyspepsia, dry mouth, muscle weakness, hallucinations, thirst, low blood pressure, dry skin, cramps;
• Disorders of water and electrolyte metabolism, which are manifested by an increase in circulating blood volume and hyponatremia, in rare cases - hyperkalemia.

In some cases, possible pain in the chest, tachycardia, thrombophlebitis, skin rash.

special instructions

Due to the high risk of pulmonary edema in patients with left ventricular insufficiency, Mannitol is prescribed in combination with high-speed loop diuretics. During the administration of the drug, blood pressure, diuresis and the concentration of electrolytes in the serum should be monitored.

Mannitol can be used in hypertensive crisis with encephalopathy, as well as in heart failure. In the latter case, it is prescribed in combination with loop diuretics.

If a headache, dizziness, vomiting, visual disturbances appear during the administration of Mannitol, the infusion should be stopped and the patient should be examined for subdural and subarachnoid hemorrhage.

When the first signs of dehydration appear, an additional injection of fluid is indicated.

If repeated administration is necessary, the infusion should be done under the control of the indicators of water-electrolyte balance of the blood.

During storage of the drug may precipitate crystals. In this case, the solution must be heated in a water bath at a temperature of 50-70 ° C until the crystals dissolve when shaken. However, before using mannitol, it must be cooled to a temperature of 36-38 ºС. To enter the solution is possible only if the crystals do not fall out again.

Drug interaction

With simultaneous use may increase the toxic effects of cardiac glycosides (due to hypokalemia).

Terms and conditions of storage

Store at a temperature of 18-20 ºС in a dry place inaccessible to children.

Shelf life - 3 years.