Details About Overdose or Poisoning Generic Salt ::  Mannitol

Mannitol

    

Drug Pharmacology ::

I. Pharmacology./b>

   

 Mannitolis an osmotically active solute diuretic. Mannitol inhibits waterreabsorption at the loop of Henle and the proximal tubule. The increasein urine output usually is accompanied by an increase in soluteexcretion. In addition, mannitol transiently increases serum osmolalityand decreases CSF pressure by creating an osmotic gradient betweenbrain tissue and the vascular compartment. Water moves across thisgradient into the blood vessels, lowering the CSF pressure anddecreasing intracranial pressure.

Mannitolmay reverse the effects of ciguatoxin by inhibiting ciguatoxin-inducedopening of sodium channels and reducing cellular excitability. Mannitolmay also increase the dissociation of ciguatoxin from its binding siteson cell membranes.

Inthe past, mannitol was used to induce “forced diuresis” for somepoisonings (eg, phenobarbital, salicylate) to enhance their renalelimination, but it has been abandoned because of lack of efficacy andpotential risks (cerebral and pulmonary edema).

Drug Indications ::

Indications

   

Proposedas a treatment for neurologic and neurosensory manifestations caused byciguatera poisoning (see Food Poisoning: Fish and Shellfish).

Possibleadjunctive agent in treating severe vitamin A toxicity associated withincreased intracranial pressure (pseudotumor cerebri).

Sometimes used as an adjunct to fluid therapy for acute oliguria resulting from massive rhabdomyolysis (see Rhabdomyolysis).

Drug Contra-Indications ::

III. Contraindications./b>

   

Severe dehydration.

Acute intracranial bleeding.

Pulmonary edema.

Anuria associated with severe renal disease.

Drug Adverse Effects ::

IV. Adverse effects

   

Mannitolmay cause excessive expansion of intravascular space when administeredin high concentrations at a rapid rate. This may result in congestiveheart failure and pulmonary edema.

Mannitolcauses movement of intracellular water to the extracellular space andcan produce both transient hyperosmolality and hyponatremia.

Oligoanuricrenal failure has occurred in patients receiving mannitol. Low-dosemannitol appears to result in renal vasodilating effects, whereas highdoses (> 200 g/day) may produce renal vasoconstriction.

Use in pregnancy. FDAcategory C (indeterminate). This does not preclude its acute,short-term use in a seriously symptomatic patient (see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions. No known interactions.

Drug Dose Management ::

Dosage and method of administration

   

Ciguatera poisoning. Recommendeddose is 1 g/kg administered IV over 30–45 minutes. Reportedly mosteffective when given within 1–2 days of exposure, but case reportsdescribe alleged benefit up to 8 weeks after exposure. Ciguaterapoisoning may be accompanied by dehydration that must be treated withintravenous fluids prior to the administration of mannitol.

Vitamin A–induced pseudotumor cerebri. Give 0.25 g/kg up to 1 g/kg administered intravenously.

Drug Chemical Formulations ::

Formulations

   

Parenteral. Mannitol 10% (500 mL, 1000 mL); 15% (150 mL, 500 mL); 20% (250 mL, 500 mL); 25% (50-mL vials and syringes).

The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is approximately 70 g (500 mL of 20% mannitol).

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