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Related Experiment Videos

Increases in spinal fluid osmolarity induced by mannitol.

K H Polderman1, G van de Kraats, J M Dixon

  • 1Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. k.polderman@tip.nl

Critical Care Medicine
|February 11, 2003
PubMed
Summary

Long-term mannitol use increases cerebrospinal fluid osmolarity, potentially reversing its therapeutic effect. Monitor cerebrospinal fluid osmolarity in patients receiving mannitol for over 24 hours.

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Critical Care Medicine

Background:

  • Mannitol is a standard treatment for elevated intracranial pressure and cerebral edema.
  • Its mechanism involves increasing serum osmolarity to draw water from the brain.
  • Long-term effects of mannitol on cerebrospinal fluid osmolarity are not well understood.

Purpose of the Study:

  • To investigate the impact of mannitol administration on cerebrospinal fluid (CSF) osmolarity.
  • To determine if long-term mannitol use alters the osmolarity gradient between serum and CSF.

Main Methods:

  • A controlled trial was conducted in a university teaching hospital.
  • Patients with severe head injury or subarachnoid bleeding requiring intracranial probes were included.
  • Serum and CSF osmolarity were measured in patients receiving mannitol for varying durations (24-48 hrs and >72 hrs) and in controls.

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Main Results:

  • Mannitol rapidly increased serum osmolarity in treated patients.
  • Cerebrospinal fluid osmolarity showed a slow but significant increase in both mannitol groups.
  • In patients treated for over 72 hours, the serum-CSF osmolarity gap initially widened but later decreased below baseline levels.

Conclusions:

  • Prolonged mannitol administration (over 24 hours) can lead to significant increases in CSF osmolarity.
  • This increase may be an adverse effect, potentially negating mannitol's therapeutic benefits.
  • Regular monitoring of CSF osmolarity is recommended for patients on long-term mannitol therapy, with consideration for dose reduction or discontinuation if levels rise.