Document Detail

Variation in osmotic response to sustained mannitol administration.
MedLine Citation:
PMID:  18563637     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Osmotic agents such as mannitol remain a mainstay in the management of cerebral edema and raised intracranial pressure. Some patients do not respond to sustained mannitol administration with the expected rise in serum osmolality, and this may correlate with lack of therapeutic efficacy. OBJECTIVE: To examine the variation in osmotic response to mannitol therapy and identify factors associated with a lack of an osmotic response to sustained mannitol administration. METHODS: Data on consecutive patients admitted to a Neurology/Neurosurgery Intensive Care Unit who received scheduled doses of mannitol for at least 48 h were extracted from a prospectively collected database. All patients received intravenous isotonic saline solutions and had serial measurements of serum sodium and osmolality, at least twice daily. Non-responders were defined using two thresholds, a rise in serum sodium of < or =1 or < or =5 mEq/l over the 48-hour period. RESULTS: The cohort included 167 patients the majority with intracerebral and subarachnoid hemorrhage and brain tumors. 73 patients (44%) did not respond to mannitol with a rise in sodium of > or =5 mEq/l, and 37 (22%) did not see a rise of 1 mEq/l over 48 h of treatment. There were minor differences between responders and non-responders (> or =5 mEq/l) in terms of age (56 +/- 15 vs. 48 +/- 14), total mannitol dose (0.9 +/- 0.2 vs. 0.7 +/- 0.2 g/kg), and cumulative fluid balance at 72 h (91 +/- 1653 vs. -610 +/- 1692 ml). Multivariate analysis found that younger age, lower weight-adjusted mannitol dose, and more negative fluid balance were associated with lack of osmotic response. DISCUSSION: A substantial proportion of patients receiving sustained mannitol do not manifest the expected osmotic response. This lack of response may correlate with the failure of clinical efficacy seen in a subgroup of patients, who then require alternate agents such as hypertonic saline. This association merits further exploration.
Salah G Keyrouz; Rajat Dhar; Michael N Diringer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Neurocritical care     Volume:  9     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2008  
Date Detail:
Created Date:  2008-09-23     Completed Date:  2008-12-19     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  204-9     Citation Subset:  IM    
Department of Neurology and Neurological Surgery, Washington University, St. Louis, MO, 63110, USA.
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MeSH Terms
Brain Edema / drug therapy*,  etiology,  metabolism*
Brain Neoplasms / complications,  metabolism
Databases, Factual
Diuretics, Osmotic / administration & dosage*
Intracranial Hypertension / drug therapy*,  etiology,  metabolism*
Mannitol / administration & dosage*
Middle Aged
Osmolar Concentration
Osmotic Pressure / drug effects
Regression Analysis
Retrospective Studies
Subarachnoid Hemorrhage / complications,  metabolism
Treatment Outcome
Grant Support
NS535966/NS/NINDS NIH HHS; P01 NS035966-090003/NS/NINDS NIH HHS
Reg. No./Substance:
0/Diuretics, Osmotic; 69-65-8/Mannitol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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