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Acute renal failure following massive mannitol infusion
Angel J Pérez-Pérez1, Beatriz Pazos, José Sobrado
1Department of Nephrology, Hospital Xeral de Vigo, Servicio Galego de Saúde, Spain. javier.perez.perez@sargas.es
American Journal of Nephrology
|October 17, 2002
Summary
Overuse of mannitol can lead to acute renal failure (ARF), even in young adults. This study highlights four male cases experiencing ARF after high-dose mannitol infusions, emphasizing the need for careful dosage monitoring.
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.