Mannitol - instructions for use, dose, side effects, contraindications

Pharmacodynamics:Osmotic diuretic. By increasing the osmotic pressure of the plasma and filtration without subsequent reabsorption leads to water retention in the tubules and an increase in the volume of urine. Raising the osmolarity of the blood plasma, causes the fluid to move from the tissues (in particular, the eyeball, brain) to the vascular bed. Does not affect glomerular filtration. Diuresis is accompanied by a moderate increase in natriuresis without a significant effect on the excretion of potassium ions.The diuretic effect is higher, the higher the concentration (dose).
Ineffective in violation of the filtration function of the kidneys, as well as in the case of azotemia in patients with cirrhosis and ascites. Causes an increase in bcc.

Pharmacokinetics:The volume of mannitol distribution is low and corresponds to the volume of the extracellular fluid, since it is distributed only in the extracellular space. Does not penetrate through cellular and tissue barriers (for example, placental, blood-brain). It can undergo a slight metabolism in the liver with the formation of glycogen.
The half-life is about 100 minutes. It is excreted by the kidneys. Excretion is regulated by glomerular filtration without significant involvement of tubular reabsorption and secretion. After iv introduction, 100 g mannitol, 80% of it is determined in urine for 3 hours. In renal failure, the half-life may increase to 36 hours.

Indications:Edema of the brain; intracranial hypertension (with renal or renal-hepatic insufficiency); epileptic status, acute attack of glaucoma, oliguria in acute renal (with preserved filtration function of the kidneys) and / or liver failure (as part of combination therapy); posttransfusion complications,caused by the introduction of incompatible blood; The forced diuresis at poisoning with barbiturates and salicylates; prevention of hemolysis in surgical interventions using extracorporeal circulation (to prevent kidney ischemia and related acute renal failure).

ICD-10

VI.G40-G47.G41 Epileptic status

VI.G90-G99.G93.2 Benign intracranial hypertension

VI.G90-G99.G93.6 Edema of the brain

VII.H40-H42.H40 Glaucoma

VII.H40-H42.H40.0 Suspicion of glaucoma

VII.H40-H42.H40.1 Primary open angle glaucoma

VII.H40-H42.H40.2 Primary angle-closure glaucoma

XI.K70-K77.K72 Hepatic failure, not elsewhere classified

XIV.N17-N19.N17 Acute kidney failure

XVIII.R30-R39.R34 Anuria and oliguria

XIX.T36-T50.T39 Poisoning by non-opioid analgesic, antipyretic and antirheumatic agents

XIX.T36-T50.T42 Poisoning with anticonvulsant, sedative, hypnotics, and anti-Parkinsonics

XIX.T80-T88.T80.3 Response to ABO-incompatibility

XXI.Z20-Z29.Z29.8 Other specified preventive measures

XXI.Z40-Z54.Z48.9 Subsequent surgical care, unspecified

Contraindications:Hypersensitivity, a violation of the filtration function of the kidneys,anuria on the background of acute renal tubular necrosis, left ventricular failure (especially accompanied by pulmonary edema), chronic heart failure of III-IV functional class; hemorrhagic stroke, subarachnoid hemorrhage (except bleeding during trepanation of the skull), severe forms of dehydration, hyponatremia, hypochloremia, hypokalemia, breach of the BBB permeability. For children under 18 years of age, the efficacy and safety of mannitol has not been established.

Carefully:Pregnancy, lactation, elderly age, severe renal dysfunction

Pregnancy and lactation:Adequate and strictly controlled studies in humans have not been conducted. In animal studies, there was no teratogenic effect.
The use of mannitol in pregnancy is possible in cases where the intended benefit to the mother exceeds the possible risk to the fetus.
Data on the isolation of mannitol with breast milk are absent.
Action category for the fetus by FDA - B

Dosing and Administration:Intravenously (slowly spray or drip) in the form of 10-20% solution. The dose depends on the age, body weight, condition of the patient and concomitant therapy.
Prophylactic dose - 0.5 g / kg, therapeutic - 1-1,5 g / kg, daily intake for adults should not exceed 140-180 g. For children - 0,25-1,0 g / kg body weight.
Before the introduction, the preparation should be heated to a temperature of 37 ° C (it is possible in a water bath).
Patients with oliguria should be previously injected in / drip a test dose (200 mg / kg) for 3-5 minutes. If after this, within 2-3 hours there will be no increase in the diuresis rate to 30-50 ml / h, further administration of the drug should be discarded.
With increased intracranial pressure, brain edema, the dose of mannitol is 1.5 to 2.0 g / kg body weight for 30-60 minutes.
When preparing a patient for surgical intervention mannitol should be administered 1-1.5 h before surgery. When operations with cardiopulmonary bypass preparation is administered in a unit dose of 20-40 g immediately before perfusion.
To ensure forced diuresis in case of poisoning with barbiturates, salicylates, postinfusion complications, the dose of mannitol should be adjusted to maintain diuresis at the level of 100 ml / h.

Side effects:From the cardiovascular system: infrequent - marked decrease in blood pressure, thrombophlebitis,rarely - anemia, increased blood pressure, insufficient blood supply to the small circle, very rarely - chronic heart failure.
From the immune system: rarely - allergic reactions, anaphylactic shock, fever.
From the side of the kidneys and urinary system: rarely - increased diuresis, osmotic nephrosis, urinary retention; very rarely acute renal failure.
From the side of metabolism: infrequently - violations of the water-electrolyte balance (increased bcc, hyponatremia, rarely - hypokalemia); rarely - dehydration, swelling.
On the part of the respiratory system: rarely - pulmonary edema, rhinitis.
From the digestive tract: nausea, vomiting, dryness of the oral mucosa.
From the sense organs: rarely - impaired visual perception.
From the skin and subcutaneous tissue: rarely - necrosis of the skin at the injection site, urticaria.
From the nervous system: rarely - headache, dizziness, convulsions, increased intracranial pressure.
Other: pain in the chest, muscle pains, chills, thirst

Overdose:The rapid administration of mannitol in high doses can lead to its accumulation, an excessive increase in the volume of extracellular fluid,hyperhydration hyponatremia and hyperkalemia, as well as to cardiac overload volume, especially in patients with acute or chronic renal failure.
Treatment is symptomatic, hemodialysis may be effective.

Interaction:Possible increase in the toxic effect of cardiac glycosides (hypokalemia).
Potentiates the diuretic effect of other diuretics.
When used simultaneously with neomycin and other aminoglycosides, it increases the risk of oto and nephrotoxicity.
Increases the excretion of lithium by the kidneys, it may be necessary to correct the vine.
Patients receiving concomitantly ciclosporin and mannitol, kidney function (risk of nephrotoxicity) should be monitored.
May intensify the effects of tubocurarine and depolarizing muscle relaxants, reduce the effectiveness of oral anticoagulants.

Special instructions:Applied only in a hospital.
Control of blood pressure, diuresis, concentration of electrolytes in blood serum (sodium, potassium) is necessary.
In case of appearance of a headache, vomiting, dizziness, visual impairment upon introduction, discontinue the introduction and exclude the development of such a complication,as subdural and subarachnoidal hemorrhage. When signs of dehydration appear, it is necessary to introduce liquid into the body.
Possible use in heart failure (only in combination with loop diuretics) and hypertensive crisis with encephalopathy.
The repeated administration of mannitol should be carried out under the control of indices of water-electrolyte balance of blood.
The introduction of mannitol in anuria caused by organic kidney disease can lead to the development of pulmonary edema.
10% solution can be prepared at room temperature, 15 and 20% solutions - when heated in a water bath to 37 ° C. In a 20% solution of mannitol, especially when it is cooled, crystals can be formed, for dissolution of which it is necessary to heat the vial in hot water or in an autoclave, periodically shaking. Before use, it should be cooled to body temperature or below.
The effect of mannitol on the ability to drive vehicles has not been studied.

Instructions

Mannitol (Mannitolum)