The Effect of Low Doses of Mannitol on Serum Osmolality


Authors: V. Špatenková 1;  V. Beneš III. 1;  A. Kazda 2;  D. Králová 3;  P. Suchomel 1
Authors‘ workplace: Neurocentrum, Krajská nemocnice, Liberec 1;  Katedra klinické biochemie IPVZ, Praha 2;  Institut biostatistiky a analýz, Lékařská a Přírodovědecká fakulta MU, Brno 3
Published in: Cesk Slov Neurol N 2008; 71/104(1): 61-65
Category: Original Paper

Overview

Introduction:
Mannitol is still used for the reduction of intracranial pressure in various acute brain diseases, especially if they are associated with cerebral oedema. The aim of this study was to establish the effect of low but often prescribed doses of mannitol on measured serum osmolality. 

Methods:
The prospective observational study was carried out on 60 patients admitted to the neurologic-neurosurgical intensive care unit (NNICU) over a period of three years, who fulfilled the inclusion criteria: 1. The patient’s clinical state (GCS 11-15) did not necessitate a higher dose of mannitol, 2. the patient received a minimum of 24 hours of 20% mannitol therapy prior to admittance to the NNICU, 3. normal renal parameters, 4. no diuretic agens, 5. hemodynamic stability and 6. normoglycaemia. Mannitol was given at 4 and 6 hour intervals with the mean individual dose of  0,17 ± 0,07 g/kg, and the mean daily dose of  0,76 ± 0,25 g/kg. Serum biochemical parameters were measured before mannitol infusion (T0), after infusion (T1) and before the next dose (T2 – 4 hours, T3 – 6 hours).

Results:
  The mean values of measured serum osmolality were around the upper reference level in all measurements (T0 = 295,5 ± 9,4 mmol/kg; T1 = 296,1 ± 8,3 mmol/kg; T2 = 294,0 ± 7,9 mmol/kg, T3 = 297,7 ± 8,0 mmol/kg), but was significantly higher only in T3 (p = 0,042). There were no significant changes either after administration of mannitol (T1, p = 0,311) or before further doses (T2, p = 0,721; T3, p = 0,710).

Conclusion:
The values of measured serum osmolality did not significantly change during low doses of 20% mannitol therapy, but the values were around the upper reference level.

Keywords:
Cerebral oedema, intracranial hypertension, mannitol, osmotic agents, serum osmolality


Sources

1. Polderman KH, van de Kraats G, Dixon JM, Vandertop WP, Girbes ARJ. Increases in spinal fluid osmolarity induced by mannitol. Crit Care Med 2003; 31: 584-590.

2. Ogden AT, Mayer SA, Connolly ES. Hyperosmolar Agents in Neurosurgical Practice: The Evolving Role of Hypertonic Saline. Neurosurgery 2005; 57: 207-215.

3. James HE. Methodology for the control of intracranial pressure with hypertonic mannitol. Acta Neurochir (Wien) 1980; 51: 161-172.

4. McGraw CP, Howard G. Effect of mannitol on increased intracranial pressure. Neurosurgery 1983; 13: 269-271.

5. Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998; 29: 1550-1555.

6. Qureshi AI, Wilson DA, Traystman RJ. Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage: Comparison between mannitol and hypertonic saline. Neurosurgery 1999; 44: 1055-1063.

7. Diringer MN, Zazulia AR. Osmotic therapy: fact and fiction. Neurocrit Care 2004; 1: 219-234.

8. Wise BL, Chater N. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal fluid pressure. J Neurosurg 1962; 19: 1038-1043.

9. Weed LH, McKibben PS. Experimental alteration of brain bulk. Am J Physiol 1919; 48: 531-555.

10. Muizelaar JP, Wei EP, Kontos HA, Becker DP. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983; 59: 822-828.

11. Burke AM, Quest DO, Chien S, Cerri C. The effects of mannitol on blood viscosity. J Neurosurg 1981; 55: 550-553.

12. Rosner MJ, Coley I. Cerebral perfusion pressure: a hemodynamic mechanism of mannitol and the postmannitol hemogram. Neurosurgery 1987; 21: 147-156.

13. Brain Trauma Foundation: Management and Prognosis of Severe Traumatic Brain Injury: The Use of Mannitol 2000; 115-124. Available from: URL: http://www2.braintrauma.org/guidelines/.

14. Luvisotto TL, Auer RN, Sutherland GR. The effect of mannitol on experimental cerebral ischemia, revisited. Neurosurgery 1996; 38: 131-139.

15. Jafar JJ, Johns LM, Mullan SF. The effect of mannitol on cerebral blood flow. J Neurosurg 1986; 64: 754-759.

16. Muizelaar JP, Lutz HA III, Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg 1984; 61: 700-706.

17. Alvarez B, Ferrer-Sueta G, Radi R. Slowing of peroxynitrite decomposition in the presence of mannitol and ethanol. Free Radic Biol Med 1998; 24: 1331-1337.

18. Cloyd JC, Snyder BD, Cleeremans B, Bundlie SR, Blomquist CH, Lakatua DJ. Mannitol pharmacokinetics and serum osmolality in dogs and humans. J Pharmacol Exp Ther 1986; 236: 301-306.

19. Albanese J, Léone M, Martin C. Severe Head Injury in Patients with Multiple Trauma. In: Vincent JL (Ed). Yearbook of Intensive Care and Emergency Medicine. Springer 2001: 353-375.

20. Rudehill A, Gordon E, Ohman G, Lindqvist C, Andersson P. Pharmacokinetics and effects of mannitol on hemodynamics, blood and cerebrospinal fluid electrolytes, and osmolality during intracranial surgery. J Neurosurg Anesthesiol 1993; 5: 4-12.

21. Visweswaran P, Massin EK, Dubose TD Jr. Mannitol-induced acute renal failure. J Am Soc Nephrol 1997; 8: 1028-1033.

22. Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF at al. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain. Crit Care Med 1998; 26: 440-446.

23. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002; 33: 136-140.

24. Suarez JI, Qureshi AI, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M et al. Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998; 26: 1118-1122.

25. Worthley LI, Cooper DJ, Jones N. Treatment of resistant intracranial hypertension with hypertonic saline: Report of two cases. J Neurosurg 1988; 68: 478-481.

26. Vialet R, Albanese J, Thomachot L, Antonini F, Bourgouin A, Alliez B at al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003; 31: 1683-1687.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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