Mannitolo Eurospital (Mannitol)

Mannitol is used in clinical settings to manage conditions involving fluid balance and pressure regulation.

• Cerebral edema: reduces brain swelling and intracranial pressure.
• Acute glaucoma: lowers intra‑ocular pressure to preserve vision.
• Acute renal failure: promotes diuresis and helps clear renal tubular obstruction.
• Hyperosmolar therapy: used intra‑operatively to protect the brain during neurosurgical procedures.

• Mannitol is a sugar alcohol that remains largely extracellular after intravenous infusion, increasing plasma osmolality. The resulting osmotic gradient draws water from intracellular compartments, such as brain tissue and ocular structures, into the vascular space, thereby decreasing intracranial and intra‑ocular pressure. In the kidneys, the elevated filtrate osmolality reduces tubular reabsorption of water and electrolytes, enhancing urine output and promoting renal clearance.

Mannitol may cause a range of adverse reactions, most of which are related to its osmotic activity and rapid fluid shifts.

Common Side Effects

• Headache: mild to moderate discomfort.
• Nausea or vomiting: gastrointestinal upset.
• Thirst or dry mouth: due to increased plasma osmolality.
• Electrolyte imbalance: especially hyponatremia or hypernatremia.
• Hypotension: transient drop in blood pressure after rapid infusion.
• Transient visual disturbances: blurred vision or visual field changes.

Serious or Rare Side Effects

• Pulmonary edema: fluid accumulation in lungs.
• Severe hyponatremia or hypernatremia: dangerous electrolyte shifts.
• Acute renal failure: paradoxical worsening of kidney function.
• Anaphylactoid reaction: rash, itching, or bronchospasm.
• Seizures: especially in patients with pre‑existing neurological conditions.
• Cardiac arrhythmia: due to electrolyte disturbances.

Mannitol should be administered with careful monitoring of fluid status and laboratory parameters.

• Renal function assessment: evaluate baseline creatinine and urine output.
• Electrolyte monitoring: check serum sodium, potassium, and osmolality regularly.
• Volume status: avoid use in severely dehydrated patients.
• Cardiovascular status: monitor blood pressure and heart rate during infusion.
• Infusion rate: administer slowly to reduce risk of hypotension and pulmonary edema.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Mannitol may interact with other agents that affect fluid balance, electrolytes, or renal function.

Major Interactions (Avoid)

• Loop diuretics: may cause excessive diuresis and electrolyte loss.
• Nephrotoxic antibiotics (e.g., aminoglycosides): increase risk of renal injury.
• Insulin: enhanced hypoglycemic effect due to altered glucose distribution.
• Hypertonic saline: additive osmotic load leading to severe hypernatremia.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may potentiate renal hypoperfusion.
• NSAIDs: can impair renal prostaglandin synthesis, affecting response.
• Antihypertensives: additive blood pressure‑lowering effect.
• Corticosteroids: may exacerbate fluid retention and electrolyte shifts.