- Increases extracellular fluid volume, plasma volume, and circulation time and dilutes extracellular stores of sodium by causing water to be drawn from cells to extracellular fluid and from erythrocytes to plasma. Fluid shifts result in reduction of cerebral edema (by reduction in brain mass) and lowering of CSF pressure.
Following IV administration:
- Lowering of elevated CSF pressure occurs within 15 minutes.
- Diuresis generally occurs within 1–3 hours.
- Lowering of elevated intraocular pressure occurs within 30–60 minutes.
- Used to reduce significantly increased intracranial pressure and cerebral edema.
- In patients with well-established anuria caused by severe renal disease or impaired renal function who do not respond to 2 test doses. (See Test Dose under Dosage and Administration.)
- Severe pulmonary congestion or frank pulmonary edema.
- Severe CHF.
- Severe dehydration.
- Metabolic edema associated with capillary fragility or membrane permeability not associated with renal, cardiac, or hepatic disease.
- Progressive renal disease or dysfunction, including increasing oliguria and azotemia, or progressive heart failure or pulmonary congestion occurring after institution of mannitol therapy.
- Fluid and Electrolyte Imbalance
- Risk of serious electrolyte disturbances (e.g., hyponatremia, hypernatremia, hypokalemia, hyperkalemia); may be severe enough to alter acid-base balance or depress respiration. Thiazides may be used if hypernatremia or hyperosmolality occurs.
- Accumulation of mannitol caused by inadequate urinary output or rapid administration of large doses may result in overexpansion of extracellular fluid and circulatory overload causing signs and symptoms of water intoxication. Overhydration may be corrected by hemodialysis or administration of a diuretic (e.g., furosemide).
- Fluid and electrolyte imbalance.
- 1.5 - 2 g/kg infused IV as a 15, 20, or 25% solution.
- 0.25 g/kg administered not more frequently than every 6–8 hours will achieve a maximum reduction of intracranial pressure.
Children >12 years of age:
- 2 g/kg or administered as a 15 or 20% solution.