Usual Adult Dose for Oliguria

Renal function test dose prior to initiation of treatment: 0.2 g/kg IV over 3 to 5 min resulting in a urine flow of at least 30 to 50 mL/hr. A second test dose may be administered if the urine flow does not increase. If no response is seen following the second test dose, the patient should be reevaluated.

Treatment: 300 to 400 mg/kg (21 to 28 g for a 70 kg patient) or up to 100 g of 15% to 20% solution IV once. Treatment should not be repeated in patients with persistent oliguria.

Prevention (for use during cardiovascular and other types of surgery): 50 to 100 g IV. usually a 5 , 10, or 20% solution is used depending on the fluid requirements of the patient.

Usual Adult Dose for Cerebral Edema

0.25 to 2 g/kg as a 15 to 20% solution IV over at least 30 min administered not more frequently than every 6 to 8 hrs.

To yield a satisfactory reduction in intracranial pressure, the osmotic gradient between the blood and cerebrospinal fluid should remain approximately 20 mOsmol.

In small &/or debilitated patients 500 mg/kg may be sufficient.

Renal Dose Adjustments

Do not initiate treatment until renal function and urinary output have been established as adequate. Mannitol is considered contraindicated in patients with well established anuria due to acute renal failure.

A test dose should be administered in patients with severe renal impairment.

Urine output should be monitored during mannitol infusion. If output declines, consideration should be given to possible discontinuation of mannitol therapy.

Liver Dose Adjustments

Data not available

Precautions

Mannitol is considered contraindicated in patients with well established anuria due to acute renal failure, severe pulmonary congestion or frank pulmonary edema, active intracranial bleeding (except during craniotomy), and severe dehydration.

Mannitol therapy should be discontinued if progression in renal damage or dysfunction, heart failure, or pulmonary congestion occurs.

A test dose should be administered in patients with severe renal impairment.

Diuresis caused by mannitol administration may exacerbate electrolyte imbalances. Electrolytes should be closely monitored, especially sodium and potassium, during mannitol administration.

Urine output should be monitored during mannitol infusion. If output declines, consideration should be given to possible discontinuation of mannitol therapy.

Neurosurgical patients receiving intravenous mannitol should be monitored for increased cerebral blood flow.

Mannitol should not be administered until renal function and urinary output are determined to be adequate.

Cardiovascular status should be established prior to rapid administration of mannitol.

Do not administer electrolyte-free mannitol solutions with blood.

Bronchial challenge testing with mannitol inhalation should not be performed in children less than 6 years of age due to their inability to provide reliable spirometric measurements.

Dialysis

Mannitol is removed by hemodialysis and peritoneal dialysis. These may be employed in the treatment of mannitol overdose.

Other Comments

Mannitol inhalation capsules should not be swallowed.

Mannitol inhalation is not a stand alone test or a screening test for asthma. Bronchial challenge testing should be used only as part of an overall assessment of asthma.