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[Mannital induced acute renal failure]
Abstract:
14 cases of mannitol-induced acute renal failure were reported. The dosage of mannitol used varied widely. In all cases serum Na+, HCO3- were decreased, K+ and BUN increased significantly. Serum osmolality was measured in 5 cases. The osmolal gap was increased greatly, 77.4mOsm/kg. H2O in average. The increase of osmolal gap may play an important role in acute renal failure by causing intensive renal vasocontraction. Monitoring of serum osmolality or osmolal gap can help to prevent mannitol intoxication. The decrease of serum Na+ may be a warning sign of increased osmolal gap. Hemodialysis is the best way for the treatment of mannitol-induced acute renal failure.
Insights
Mannitol can cause acute kidney injury, leading to electrolyte imbalances and increased osmolal gap. Monitoring serum osmolality and sodium levels can prevent mannitol intoxication, with hemodialysis being the primary treatment for this condition.
Area of Science:
- Nephrology
- Clinical Toxicology
- Internal Medicine
Context:
- Mannitol, a hyperosmolar agent, is commonly used for various medical indications.
- Acute renal failure (ARF) is a potential complication associated with mannitol administration.
- Understanding the biochemical changes and mechanisms underlying mannitol-induced ARF is crucial for patient management.
Purpose:
- To report and analyze clinical data from 14 cases of mannitol-induced acute renal failure.
- To investigate the role of serum osmolality and osmolal gap in the pathogenesis of mannitol nephrotoxicity.
- To identify key biochemical markers and recommend optimal treatment strategies for mannitol-induced ARF.
Summary:
- Analysis of 14 cases revealed consistent electrolyte disturbances, including decreased serum sodium (Na+) and bicarbonate (HCO3-), and increased potassium (K+) and blood urea nitrogen (BUN).
- Elevated osmolal gap (average 77.4 mOsm/kg H2O) was observed in cases with measured serum osmolality, suggesting a significant role in inducing renal vasoconstriction and subsequent ARF.
- Decreased serum Na+ may serve as an early indicator of an increased osmolal gap, signaling potential mannitol intoxication.
Impact:
- Highlights the importance of monitoring serum osmolality or osmolal gap to prevent mannitol-induced acute renal failure.
- Suggests that serum sodium levels can act as a warning sign for elevated osmolal gap.
- Establishes hemodialysis as the preferred treatment modality for managing mannitol-induced acute renal failure.