Acute renal failure following massive mannitol infusion

Area of Science:

• Nephrology
• Toxicology
• Critical Care Medicine

Background:

• Mannitol is commonly used as an osmotic diuretic and to reduce intracranial pressure.
• Acute renal failure (ARF) is a rare but serious complication associated with mannitol administration.
• Previous literature on mannitol-induced ARF is limited, necessitating further investigation.

Observation:

• Four male patients aged 20-42 years developed ARF after receiving high doses of mannitol (mean 1,172 g over 58 h) at an infusion rate of 0.25 g/kg/h.
• ARF onset occurred 48 hours post-infusion, with three patients experiencing anuria.
• Urinary cytology revealed vacuolated renal tubular cells in two cases, alongside hyponatremia and hyperosmolality.

Findings:

• High-dose mannitol administration was identified as the sole cause of ARF in these patients.
• Hemodialysis led to immediate diuresis in anuric patients.
• Two patients recovered renal function, while two succumbed to increased intracranial pressure.

Implications:

• This case series underscores the potential nephrotoxicity of excessive mannitol use.
• Clinicians should exercise caution with mannitol dosing, particularly in vulnerable patients.
• Prompt recognition and intervention, including hemodialysis, may improve outcomes in mannitol-induced ARF.