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Mannitol-induced acute renal failure.

H R Dorman1, J H Sondheimer, P Cadnapaphornchai

  • 1Department of Medicine, Wayne State University, School of Medicine, Detroit, Michigan.

Medicine
|May 1, 1990
PubMed
Summary
This summary is machine-generated.

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Mannitol, often used to treat brain swelling, can paradoxically cause acute kidney injury. Monitoring the osmolal gap, not just serum osmolality, is crucial for safe mannitol use in patients.

Area of Science:

  • Nephrology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Mannitol is a common osmotic diuretic used to reduce intracranial pressure and protect against certain types of acute kidney injury.
  • However, its potential to induce acute renal failure is an underrecognized complication.

Purpose of the Study:

  • To report on 8 new cases of mannitol-induced acute renal failure.
  • To review previously documented cases to better understand the incidence, clinical course, and risk factors.

Main Methods:

  • Case series analysis of 8 patients with mannitol-induced acute renal failure.
  • Literature review of previously reported cases.
  • Analysis of patient data including mannitol dosage, duration of treatment, serum creatinine, and osmolal gap.

Related Experiment Videos

Main Results:

  • Acute oliguric renal failure developed within approximately 3.5 days of mannitol administration.
  • Patients received average daily and total doses of 189g and 626g of mannitol, respectively.
  • Peak serum creatinine reached 5.7 mg/dL with a peak osmolal gap of 74 mOsm/kg water; renal function improved after mannitol withdrawal or hemodialysis.

Conclusions:

  • Mannitol can cause acute renal failure, particularly with higher cumulative doses or in patients with pre-existing renal compromise.
  • Pathogenesis may involve renal vasoconstriction due to high mannitol concentrations.
  • Monitoring the osmolal gap is recommended over serum osmolality alone for safer mannitol administration.