-
Journal of Intensive Care Medicine Jul 2023Acutely elevated intracranial pressure (ICP) may have devastating effects on patient mortality and neurologic outcomes, yet its initial detection remains difficult... (Review)
Review
Acutely elevated intracranial pressure (ICP) may have devastating effects on patient mortality and neurologic outcomes, yet its initial detection remains difficult because of the variety of manifestations that it can cause disease states it is associated with. Several treatment guidelines exist for specific disease processes such as trauma or ischemic stroke, but their recommendations may not apply to other causes. In the acute setting, management decisions must often be made before the underlying cause is known. In this review, we present an organized, evidence-based approach to the recognition and management of patients with suspected or confirmed elevated ICP in the first minutes to hours of resuscitation. We explore the utility of invasive and noninvasive methods of diagnosis, including history, physical examination, imaging, and ICP monitors. We synthesize various guidelines and expert recommendations and identify core management principles including noninvasive maneuvers, neuroprotective intubation and ventilation strategies, and pharmacologic therapies such as ketamine, lidocaine, corticosteroids, and the hyperosmolar agents mannitol and hypertonic saline. Although an in-depth discussion of the definitive management of each etiology is beyond the scope of this review, our goal is to provide an empirical approach to these time-sensitive, critical presentations in their initial stages.
Topics: Humans; Mannitol; Intracranial Hypertension; Brain Injuries, Traumatic; Brain Injuries; Saline Solution, Hypertonic; Intracranial Pressure
PubMed: 36802976
DOI: 10.1177/08850666231156589 -
Expert Review of Respiratory Medicine Feb 2013Insufficient hydration at the airway surface can make mucus adherent and poorly cleared. Cough, the major mechanism of mucus clearance in disease, is ineffective when... (Review)
Review
Insufficient hydration at the airway surface can make mucus adherent and poorly cleared. Cough, the major mechanism of mucus clearance in disease, is ineffective when mucus is adhesive. Inhaled mannitol creates an osmotic drive for water to move into the airway lumen. The consequent increased hydration of the airway surface decreases the adherence of mucus to the epithelium, facilitates the coupling of mucus and cilia thereby increasing mucus clearance. Inhaled mannitol also promotes effective coughing and stimulates mucociliary clearance. The beneficial effect of mannitol on mucus and its clearance has been demonstrated in patients with asthma, bronchiectasis and cystic fibrosis. Inhaled dry powder mannitol (Bronchitol™) is promising to be an effective treatment for the clearance of retained airway secretions.
Topics: Administration, Inhalation; Bronchiectasis; Cystic Fibrosis; Dry Powder Inhalers; Humans; Mannitol; Mucociliary Clearance; Mucus; Powders; Treatment Outcome
PubMed: 23362816
DOI: 10.1586/ers.12.72 -
The Journal of Chemical Physics Aug 2022The kinetics of the first order liquid-liquid transition (LLT) in a single-component liquid D-mannitol have been examined in detail by the high rate of flash...
The kinetics of the first order liquid-liquid transition (LLT) in a single-component liquid D-mannitol have been examined in detail by the high rate of flash differential scanning calorimetry measurements. By controlling the annealing temperature, the phase X formation from the supercooled liquid is distinguished by either a nucleation-growth or a spinodal-decomposition type of LLT. In the measured time-temperature-transformation curve the portion covering the nucleation-growth type of LLT can be well fitted with a classical nucleation theory analysis.
Topics: Calorimetry, Differential Scanning; Kinetics; Mannitol; Temperature
PubMed: 35987598
DOI: 10.1063/5.0097865 -
Acta Crystallographica. Section C,... Feb 1996The central six-C-atom chain of the title compound, C52H50O10, adopts a nearly planar extended conformation free from C parallel C, C parallel O and O parallel O...
The central six-C-atom chain of the title compound, C52H50O10, adopts a nearly planar extended conformation free from C parallel C, C parallel O and O parallel O 1,3-parallel interactions. The three torsion angles formed by these atoms have values of 177.4 (2), 174.2 (2) and -178.0 (2) degrees. The bulky triphenylmethyl groups, which are oriented gauche to their neighboring acetoxy groups with O--C--C--O torsion angles of -69.8 (2) and -63.0 (2) degrees, cause no distortion of the bond lengths and bond angles of the sugar moiety.
Topics: Crystallography, X-Ray; Mannitol; Molecular Conformation
PubMed: 8829361
DOI: 10.1107/s0108270195013618 -
The Medical Letter on Drugs and... Jan 1968
Topics: Acute Kidney Injury; Anuria; Diuretics; Humans; Mannitol
PubMed: 5636639
DOI: No ID Found -
Artificial Organs May 1979The extensive use of mannitol during maintenance hemodialysis prompted a study of mannitol kinetics. In 17 patients receiving empirical mannitol therapy of mannitol...
The extensive use of mannitol during maintenance hemodialysis prompted a study of mannitol kinetics. In 17 patients receiving empirical mannitol therapy of mannitol kinetics. In 17 patients receiving empirical mannitol therapy, residual levels range from 19 to 100 mg% In vitro mannitol clearance exceeds 125 ml/min for the CDAK 5 and PF 1.6 dialyzers, while in vivo clearance ranges from 98 to 140 ml/min in the Triex 1, PF 1.6 and CDAK 5. Despite an apparently adequate clearance rate, mannitol administered during dialysis is incompletely removed. Repeated use of mannitol during dialysis leads to mannitol accumulation. Clinical significance of the residual mannitol levels needs further evaluation.
Topics: Humans; Kidneys, Artificial; Mannitol; Renal Dialysis
PubMed: 119523
DOI: No ID Found -
Recent Patents on Biotechnology 2008Mannitol is a 6-carbon sugar alcohol that has been produced traditionally by chemical catalysis. Biotechnology has brought advances to the production in terms of... (Review)
Review
Mannitol is a 6-carbon sugar alcohol that has been produced traditionally by chemical catalysis. Biotechnology has brought advances to the production in terms of substrate purity, process equipment requirements and safety. Enzymatic methods have improved the yields and the use of microbes has brought versatility to the range of substrates that can be used in the processes. Some of the microbial processes are already industrially feasible and could be taken to further use. The most promising production strategy reported so far has been the utilization of non-growing cells of heterofermentative lactic acid bacteria for converting fructose to mannitol. The latest developments in the field have dealt with the use of recombinant strains in mannitol production.
Topics: Bioreactors; Biotechnology; Fungi; Mannitol; Patents as Topic
PubMed: 19075855
DOI: 10.2174/187220808784619702 -
Clinical Infectious Diseases : An... Nov 2014Childhood gut dysfunction (enteropathy) is common in resource-poor environments. Stunting is its presumed major consequence. Identification of biomarkers of gut... (Review)
Review
Childhood gut dysfunction (enteropathy) is common in resource-poor environments. Stunting is its presumed major consequence. Identification of biomarkers of gut dysfunction could identify the presence of, and, ideally, assess interventions for, enteropathy. Classically, enteropathy has been identified histopathologically. However, less invasive assays may be more sensitive for detecting earlier perturbations reflecting specific functional derangements. The most commonly used test has been the urinary lactulose to mannitol ratio (L:M), which primarily assesses gut leakiness, and which also measures absorption. We systematically reviewed the L:M literature published from 2000 to 2010 pertinent to children in developing country settings, and identified 25 relevant publications representing heterogeneous studies. We conclude that the L:M test has many attributes, including reflecting 2 physiologic processes (absorption and permeability) and likely correlation with growth failure consequent to child gut dysfunction. However, improved test technical performance, data reporting, and correlation with host phenotypes are needed to maximize the utility of this test.
Topics: Biomarkers; Child, Preschool; Developing Countries; Diagnostic Techniques, Digestive System; Environment; Humans; Infant; Infant, Newborn; Intestinal Diseases; Lactulose; Mannitol; Nutrition Disorders; Poverty
PubMed: 25305289
DOI: 10.1093/cid/ciu541 -
American Journal of Nephrology 1989A case of mannitol-induced renal failure is described and previously reported cases are reviewed. Possible mechanisms of the etiology are discussed. (Review)
Review
A case of mannitol-induced renal failure is described and previously reported cases are reviewed. Possible mechanisms of the etiology are discussed.
Topics: Acute Kidney Injury; Aged; Glaucoma; Humans; Male; Mannitol; Renal Dialysis
PubMed: 2500855
DOI: 10.1159/000167946 -
BMC Cancer Apr 2022Saline hydration with addition of mannitol have commonly been the strategy to avoid cisplatin induced acute kidney injury (AKI). While the initial reports demonstrated...
BACKGROUND
Saline hydration with addition of mannitol have commonly been the strategy to avoid cisplatin induced acute kidney injury (AKI). While the initial reports demonstrated that mannitol diuresis decreased cisplatin induced renal injury, others have shown renal injury to be worsened.
OBJECTIVE
To compare the risk of AKI in cancer patients receiving high dose cisplatin with and without addition of mannitol.
METHOD
This was an ambispective cohort study based on consecutive sampling at Cipto Mangunkusumo General Hospital (CMGH) and Mochtar Riady Comprehensive Cancer Centre (MRCCC) Siloam Hospitals. The data was obtained from September 2017 to February 2018. The choice of mannitol administration based on attending physician clinical judgement. The primary outcome was increase of serum creatinine more than 0.3 mg/dL or 1.5 times from baseline. Analysis was done by using univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of cisplatin induced AKI probability caused by mannitol addition on top of usual saline hydration protocol.
RESULT
Data from 110 patients (57.3% male) with a median age of 44.5 years (range 19 to 60 years) were collected; 63 received saline with the addition of mannitol and 47 received saline only. Incidence of AKI were higher in mannitol vs saline only group. Bivariate analysis showed higher probability of post chemotherapy AKI in mannitol group, however it was statistically insignificant (RR 2.168; 95% CI 0.839-5.6; p = 0.094). On multivariate analysis the age adjusted RR was 2.852 (95% CI 0.68-11.96; p = 0.152).
CONCLUSION
The addition of mannitol to hydration did not reduce the risk of cisplatin induced AKI as compared with saline hydration only. It was also found that risk for acute kidney injury were higher in population ≥ 40 years old.
Topics: Acute Kidney Injury; Adult; Antineoplastic Agents; Cisplatin; Cohort Studies; Female; Humans; Male; Mannitol; Middle Aged; Young Adult
PubMed: 35413808
DOI: 10.1186/s12885-022-09456-w