Parenteral Manual

Mannitol

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
OSMITROL®
Classification: 
Diuretic, Osmotic
Original Date: 
August 2005
Revised Date: 
October 2016
Indications: 
  • 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.
Compatibility: 

- 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

Administration: 

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

SC NO
IM NO
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
Dosage: 

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

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

Pediatric/Adult:

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
Notes: 

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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