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Mannitol intoxication in patients with renal failure.

H F Borges, J Hocks, C M Kjellstrand

    Archives of Internal Medicine
    |January 1, 1982
    PubMed
    Summary

    Severe mannitol intoxication requires prompt treatment. Hemodialysis is the ideal treatment, rapidly removing mannitol and managing fluid overload, unlike slower peritoneal dialysis.

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    Area of Science:

    • Nephrology
    • Toxicology
    • Critical Care Medicine

    Background:

    • Mannitol intoxication presents with severe central nervous system (CNS) involvement, hyponatremia, and fluid overload.
    • Patients exhibit a significant osmolality gap, indicating a discrepancy between measured and calculated serum osmolality.
    • Uremia may not fully explain the observed CNS symptoms in these cases.

    Purpose of the Study:

    • To evaluate the efficacy of different dialysis modalities in treating severe mannitol intoxication.
    • To determine the pharmacokinetic profile of mannitol in intoxicated patients.
    • To compare hemodialysis and peritoneal dialysis for mannitol removal.

    Main Methods:

    • Retrospective analysis of eight patients with severe mannitol intoxication over ten years.
    • Treatment modalities included hemodialysis and peritoneal dialysis.
    • Mannitol half-life was calculated during treatment and non-treatment intervals.

    Main Results:

    • Hemodialysis demonstrated a significantly faster mannitol removal rate (half-life of six hours) compared to peritoneal dialysis (half-life of 21 hours).
    • Mannitol had a prolonged half-life of approximately 36 hours without active treatment.
    • One patient died due to delayed treatment initiation.

    Conclusions:

    • Hemodialysis is the preferred treatment for severe mannitol intoxication due to its rapid clearance of mannitol and ability to correct electrolyte imbalances.
    • Peritoneal dialysis is less effective for rapid mannitol removal.
    • Prompt initiation of appropriate dialysis is crucial for patient survival.

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