[Acute renal failure following mannitol infusion]

Area of Science:

• Nephrology
• Critical Care Medicine

Background:

• Mannitol is an osmotic diuretic commonly used for intracranial hypertension, cerebral edema, and glaucoma.
• It is renally excreted and metabolically inert.

Observation:

• Two patients developed reversible acute oliguric renal failure after mannitol infusion for intracranial hypertension.
• Symptoms included nausea, vomiting, lethargy, generalized edema, and congestive heart failure.
• Laboratory findings revealed severe dilutional hyponatremia with hyperosmolarity.

Findings:

• Mannitol accumulation in renal impairment can lead to fluid shifts and cellular dehydration.
• Successful treatment was achieved using extracorporeal ultrafiltration method (ECUM) and hemodialysis (HD).

Implications:

• Highlights the risk of mannitol-induced acute kidney injury in patients with compromised renal function.
• Demonstrates the efficacy of ECUM and HD in managing this specific complication.
• Suggests careful patient selection and monitoring when administering mannitol to at-risk individuals.