Parenteral Manual


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Alternate Name(s): 
Diuretic, Osmotic
Original Date: 
August 2005
Revised Date: 
October 2016
  • To reduce increased intracranial pressure associated with cerebral edema
  • To promote diuresis in treatment of oliguria or anuria
  • To reduce increased intraocular pressure
  • To promote urinary excretion of toxic substances
  • Treatment of edema and ascites
Reconstitution and Stability: 
  • Store at room temperature
  • Crystallization may occur at low temperatures - do not use solutions that contain crystals; heating in a hot water bath and vigorous shaking may be used to resolubilize the crystals; cool solutions to body temperature before using
  • An administration set with a filter (<5 micron) must be used for mannitol infusion with concentrations >20%.
  • Abbott suggests that rates <10 mL/min (600 mL/hr) require a 0.22 micron filter.

- Solutions Compatible: D5W, 0.9% NaCl, D5NS, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: TPN

Incompatible: blood products, imipenem-cilastatin,  G-CSF (filgrastim), meropenem, pantoprazole, strongly acidic or alkaline solutions, addition of potassium or sodium chloride to  20-25% mannitol


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

YES: Oliguria test dose
Usual dilution: <25%
Infusion time: 3-5 minutes

IV Intermittent Infusion

YES: Cerebral edema, Elevated ICP
Usual dilution: <25%
Infusion time:  20-30 minutes

IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • The rate, dosage and concentration will vary with the indication and patients clinical state.


Acute renal failure (oliguria)

- Test dose for oliguria:

  • 200 mg/kg IV to produce a urine flow of at least 1 mL/kg/hr for 1-3 hours
  • Maximum:  12.5 g/dose
  • Pediatric: aim to produce a urine flow of at least 1 mL/kg/hour for 1-3 hours
  • Adult: aim to produce a urine flow of at least 30-50 mL of urine/hour over next 2-3 hours
  • If response is not adequate, a second dose may be given.  If no diuresis after second dose, discontinue mannitol

- Initial:                        

  • 0.5-1 g/kg IV as a 20% solution

- Maintenance:         

  • 0.25-0.5 g/kg/dose IV Q 4-6 hours  

Intracranial pressure (ICP) reduction 

  • 0.25 - 1 g/kg/dose
Potential hazards of parenteral administration: 
  • Thrombophlebitis, tissue necrosis on extravasation
  • Congestive heart failure, circulatory overload
  • Fluid and electrolyte imbalance, hypo- or hypernatremia, hypo- or hyperkalemia,
  • Pulmonary edema
  • Headache, convulsions

Contraindicated in severe pulmonary edema or congestion, dehydration, active intracranial bleeding, renal disease that does not respond to test dose

  • Monitor renal function, ins and outs, serum electrolytes, serum and urine osmolality
  • Mannitol 20%  (20 g/100 mL) = osmolarity of 1100 mOsm/L

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