-
Proceedings of the Society For... Oct 1948
Topics: Biochemical Phenomena; Carbohydrate Metabolism; Mannitol
PubMed: 18889813
DOI: 10.3181/00379727-69-16648 -
Lung 2002We had previously studied different modes of prevention of liver ischemia-reperfusion (IR)-induced remote organ reperfusion injury, a challenge that remains partly...
We had previously studied different modes of prevention of liver ischemia-reperfusion (IR)-induced remote organ reperfusion injury, a challenge that remains partly unmet. We have now studied the capability of mannitol at different doses in abrogating liver IR-induced lung reperfusion injury in an isolated double-organ model. Rat livers ( n = 8/group) were perfused with Krebs-Henseleit solution (control) or made globally ischemic (IR) for 2 h, after which they were paired with normal lungs and "reperfused" together for 15 min. The lungs were then perfused alone with the accumulated Krebs for an additional 45 min. Another 4 control and 4 IR pairs were reperfused with Krebs containing mannitol at.22 mmol,.55 mmol,.77 mmol, or 1.1 mmol. Mannitol.22 mmol and 1.1 mmol failed to attenuate IR-lung injury as indicated by 50-95% increases in inspiratory and perfusion pressures and compliance reduction, a 70% increase in weight gain, and a 2-50-fold increase in bronchoalveolar lavage volume and content. Mannitol.55 mmol prevented all these abnormalities, and.77 mmol attenuated only changes in ventilatory parameters. The latter two treatments were also associated with a 50% reduction in xanthine oxidase activity and a 35-45% increase in the reduced glutathione tissue content compared with the nontreated IR-paired lungs. It is concluded that mannitol in a narrow therapeutic dose range can reduce oxidalive stress-induced lung damage that is related to liver IR.
Topics: Animals; Diuretics, Osmotic; Dose-Response Relationship, Drug; Liver; Lung; Male; Mannitol; Perfusion; Rats; Rats, Wistar; Reperfusion Injury
PubMed: 12647234
DOI: 10.1007/s00408-002-0105-8 -
Nutrition Reviews Jun 1954
Topics: Carbohydrate Metabolism; Humans; Mannitol; Sorbitol
PubMed: 13166145
DOI: 10.1111/j.1753-4887.1954.tb03269.x -
Journal of Clinical Pharmacology May 2010To better understand mannitol pharmacokinetics, the authors constructed and compared population models for high-versus low-dose bolus infusions in humans. Patients (aged... (Randomized Controlled Trial)
Randomized Controlled Trial
To better understand mannitol pharmacokinetics, the authors constructed and compared population models for high-versus low-dose bolus infusions in humans. Patients (aged 18-75, American Society of Anesthesiologists physical status 1-3) scheduled for elective craniotomy with an anticipated need for intraoperative mannitol were randomly assigned to receive either 0.5 (n = 10) or 1.0 (n = 12) g/kg of 20% mannitol over 15 minutes. Serial blood samples were collected at the predetermined intervals over 12 hours. Plasma mannitol concentrations were measured by gas chromatography and subjected to pharmacokinetic analysis; a 3-compartment model best described mannitol disposition characteristics. Weight and dose were the important covariates for rapid peripheral volume of distribution (V2) and central clearance (CL1), respectively. Estimated population means were 2.80, 8.86, and 12.0 L for central (V1), rapid (V2), and slow (V3) volumes of distribution, respectively. Clearances of the central compartments (CL1) were 0.07 versus 0.04 L/min in the high-versus low-dose group, respectively. Thus, mannitol kinetics can be considered as nonlinear. Clearances of the rapid peripheral (CL2) and slow peripheral compartments (CL3) were identical (2.07 and 0.16 L/min) in both. The current weight-based dosing guidelines yielded greater than expected plasma drug concentrations in obese patients.
Topics: Adolescent; Adult; Aged; Body Weight; Chromatography, Gas; Craniotomy; Diuretics, Osmotic; Dose-Response Relationship, Drug; Female; Humans; Infusions, Intravenous; Intraoperative Care; Male; Mannitol; Middle Aged; Models, Biological; Tissue Distribution; Young Adult
PubMed: 20051588
DOI: 10.1177/0091270009348973 -
Seminars in Ophthalmology 2017To evaluate the effect of intravenous mannitol (IVM) on intraocular pressure (IOP) in vitrectomized eyes.
PURPOSE
To evaluate the effect of intravenous mannitol (IVM) on intraocular pressure (IOP) in vitrectomized eyes.
METHODS
Thirty-one patients with raised IOP after retinal surgery with silicone oil injection were included. Patients were administered IVM (20% solution, 1g/Kg, over 30 minutes) and IOP was noted at regular intervals. IOP reduction in vitrectomized eyes (Group 1) was compared with the normal eyes (Group 2).
RESULT
Percentage IOP reduction was higher in Group 1 than in Group 2 at all time intervals, 24.5% vs. 19.2% at 15 minutes (p=0.34), 22.6% vs. 9.8% at 45 minutes (p=0.003), 19.1% vs. 9.9% at two hours (p=0.023), and 16.1% vs. 7.8% at four hours (p=0.04), respectively. In Group 1, 40% eyes had an IOP reduction of 2-6 mmHg while 30% eyes had IOP reduction >6 mmHg at four hours post-IVM.
CONCLUSION
IVM is useful for short-term IOP reduction in vitrectomized eyes. IOP reduction is independent of baseline IOP, and sustained and higher as compared to normal eyes.
Topics: Adolescent; Adult; Aged; Case-Control Studies; Female; Humans; Injections, Intravenous; Intraocular Pressure; Male; Mannitol; Middle Aged; Ocular Hypertension; Silicone Oils; Tonometry, Ocular; Vitrectomy; Young Adult
PubMed: 27367233
DOI: 10.3109/08820538.2016.1169301 -
Bulletin de La Societe de Pathologie... 1992Intravenous mannitol was introduced as an effective treatment for ciguatera in 1988. Clinicians have used intravenous mannitol with success in several geographic areas.... (Review)
Review
Intravenous mannitol was introduced as an effective treatment for ciguatera in 1988. Clinicians have used intravenous mannitol with success in several geographic areas. However, there remains a general skepticism and reluctance to use mannitol to treat ciguatera amongst clinicians. The possible reasons for the clinician's reluctance to use intravenous mannitol to treat ciguatera are reviewed.
Topics: Animals; Ciguatera Poisoning; Fishes; Humans; Infusions, Intravenous; Mannitol
PubMed: 1340337
DOI: No ID Found -
Journal of Neurosurgery Jan 2008Brain edema can increase intracranial pressure (ICP), potentially leading to ischemia, herniation, and death. Edema and elevated ICP are often treated with osmotic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Brain edema can increase intracranial pressure (ICP), potentially leading to ischemia, herniation, and death. Edema and elevated ICP are often treated with osmotic agents to remove water from brain tissue. Mannitol is the osmotic diuretic most commonly used in the intensive care unit; however, despite its clinical importance, treatment protocols vary from center to center, and the dose-response relationship is not understood. The goal of this metaanalysis was to aggregate and analyze data from studies in which authors have described the dose-response relationship between mannitol and ICP.
METHODS
The authors identified 18 studies that quantitatively characterized the dose-response relationship of mannitol and ICP. We also examined study designs and mannitol administration protocols.
RESULTS
Meta-regression found a weak linear relationship between change in ICP (delta ICP) and dose (delta ICP = 6.6 x dose - 1.1; p = 0.27, R(2) = 0.05). The lack of statistical significance could reflect the variation in protocols among studies and the variation in patients both within and among studies. However, the authors found a highly significant difference (p < 0.001) in decrease in ICP when the initial ICP was higher or lower than 30 mm Hg. Nonlinear regression suggested that ICP decrease is greatest shortly after mannitol is given (R(2) = 0.63). Finally, the authors found that recent studies tend to include fewer patients and set a lower ICP threshold for mannitol administration but report more parameters of interest; the duration of mannitol's effect was the most frequently unreported parameter.
CONCLUSIONS
Despite its clinical importance, the determination of the mannitol dose-response curve continues to be challenging for many reasons. This metaanalysis highlights the need for a consensus of methods and results required to determine this important relationship.
Topics: Diuretics, Osmotic; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Intracranial Pressure; Mannitol
PubMed: 18173314
DOI: 10.3171/JNS/2008/108/01/0080 -
Journal of Clinical Neuroscience :... Aug 2017Mannitol and hypertonic saline (HS) are most commonly used hyperosmotic agents for intraoperative brain relaxation. We compared the changes in ICP and systemic... (Comparative Study)
Comparative Study Randomized Controlled Trial
Mannitol and hypertonic saline (HS) are most commonly used hyperosmotic agents for intraoperative brain relaxation. We compared the changes in ICP and systemic hemodynamics after infusion of equiosmolar solutions of both agents in patients undergoing craniotomy for supratentorial tumors. Forty enrolled adults underwent a standard anesthetic induction. Apart from routine monitoring parameters, subdural ICP with Codmann catheter and cardiac indices by Vigileo monitor, were recorded. The patients were randomized to receive equiosmolar solutions of either 20% mannitol (5ml/kg) or 3% HS (5.35ml/kg) for brain relaxation. The time of placement of ICP catheter was marked as T and baseline ICP and systemic hemodynamic variables were noted; it was followed by recording of the same parameters every 5min till 45min (Study Period). After the completion of study period, brain relaxation score as assessed by the neurosurgeon was recorded. Arterial blood gas (ABG) was analysed every 30min starting from T upto one and half hours (T), and values of various parameters were recorded. Data was analysed using appropriate statistical methods. Both mannitol and HS significantly reduced the ICP; the values were comparable in between the two groups at most of the times. The brain relaxation score was comparable in both the groups. Urine output was significantly higher with mannitol. The perioperative complications, overall hospital stay, and Glasgow outcome score at discharge were comparable in between the two groups. To conclude, both mannitol and hypertonic saline in equiosmolar concentrations produced comparable effects on ICP reduction, brain relaxation, and systemic hemodynamics.
Topics: Adolescent; Adult; Brain; Craniotomy; Female; Hemodynamics; Humans; Intracranial Pressure; Male; Mannitol; Middle Aged; Saline Solution, Hypertonic
PubMed: 28342705
DOI: 10.1016/j.jocn.2017.03.016 -
Journal of Clinical Pharmacy and... Apr 2021Glycerol is thought to be superior to mannitol in the treatment of cerebral oedema and elevated intracranial pressure (ICP), particularly with safety concerns. However,... (Meta-Analysis)
Meta-Analysis
WHAT IS KNOWN AND OBJECTIVE
Glycerol is thought to be superior to mannitol in the treatment of cerebral oedema and elevated intracranial pressure (ICP), particularly with safety concerns. However, the current evidence remains insufficient. Therefore, we aimed to compare the efficacy and safety of glycerol versus mannitol in this meta-analysis.
METHODS
PubMed, EMBASE, Web of Science, CENTRAL, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP information, ClinicalTrials.gov, and the reference lists of relevant articles were searched for randomized controlled trials comparing glycerol and mannitol in patients with brain oedema and elevated ICP. Two investigators independently identified the articles, assessed the study quality and extracted data. Data analyses were performed using RevMan software.
RESULTS AND DISCUSSION
Thirty trials involving 3144 patients met our inclusion criteria. Pooled data indicated that glycerol and mannitol had comparable effectiveness in controlling cerebral oedema (RR, 1.00; 95% CI, 0.97 to 1.03; p = .97), but the risks of acute kidney injury and electrolyte disturbances were significantly lower with glycerol (RR, 0.21; 95% CI, 0.16 to 0.27 and RR, 0.23; 95% CI, 0.17 to 0.30, respectively) than mannitol. Moreover, there seemed to be a lower probability of rebound ICP after the withdrawal of glycerol. Neither haemolysis nor elevated blood glucose levels were observed in the glycerol group.
WHAT IS NEW AND CONCLUSION
Regarding the balance between efficacy and safety, glycerol could be an effective and more tolerable alternative therapy for cerebral oedema and elevated ICP than mannitol, especially for high-risk populations of renal failure.
Topics: Brain Edema; China; Diuretics, Osmotic; Glycerol; Humans; Intracranial Hypertension; Mannitol; Randomized Controlled Trials as Topic
PubMed: 33217016
DOI: 10.1111/jcpt.13314 -
American Journal of Ophthalmology Feb 1981When prescribing mannitol to decrease intraocular pressure, the physician must be alert to potential complications. A 72-year-old woman suffered obtundation, intractable...
When prescribing mannitol to decrease intraocular pressure, the physician must be alert to potential complications. A 72-year-old woman suffered obtundation, intractable pulmonary edema, acidemia, and irreversible renal insufficiency despite vigorous hemodialysis. When renal function is compromised, careful monitoring of electrolyte levels, daily urine output, and renal function is necessary with mannitol therapy.
Topics: Aged; Anuria; Aphakia, Postcataract; Female; Glaucoma; Humans; Intraocular Pressure; Mannitol; Pulmonary Edema
PubMed: 6781355
DOI: 10.1016/0002-9394(81)90190-2