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Osmotic Diuretics

Mannitol is filtered by the renal glomeri and not reabsorbed, exerting strong osmotic draw.1

Indications
  • Mannitol is used in ITU settings to treat cerebral oedema due to trauma,subarachnoid haemorrhage and tumour as a rapid intravenous infusion. There is some evidence that high dose mannitol is better than conventional dose mannitol in the acute management of comatose patients with severe head injury but also that prolonged use may actually worsen the clinical situation as the mannitol passes across the blood brain barrier, raising intracranial pressure (ICP).2
  • The routine use of mannitol in the management of all patients with acute stroke is not currently supported by trial evidence.[R28916
  • Mannitol is used as an adjunctive treatment in cerebral malaria. However there are no available RCTs to support this use and the WHO does not recommend it.3
  • It is also used in the emergency treatment of acute closed-angle glaucoma prior to surgery.
  • Osmotic diuretics are rarely given in heart failure as they may acutely expand the blood volume.
  • Mannitol is sometimes used to promote the excretion of toxic substances (such as barbiturates or aspirin) in overdose situations.
  • Mannitol has been used with the aim of preventing contrast nephropathy (rise in creatinine of >25% following use of contrast media) but this is not recommended as it appears to increase the likelihood of nephrotoxicity.4
  • Inhaled mannitol is used experimentally to test bronchial airway hyperresponsiveness and aid diagnosis of asthma.5
Contraindications6
  • Congestive cardiac failure
  • Pulmonary oedema
  • Abnormal capillary fragility
  • Renal failure with anuria
  • Severe dehydration
Cautions6
  • Pregnancy (safety not established)
  • Poor cardiac reserve
  • Severe renal impairment
  • Hyponatraemia
Side-effects6

Side-effects of intravenous mannitol include:

  • Fever and chills
  • Nausea and vomiting
  • Hypotension and dizziness
  • Urinary retention
  • Increased thirst
  • Headache and confusion
  • Chest pain
  • Blurred vision
Interactions

See individual drug monograph

Document References
  1. British National Formulary; BNF
  2. Wakai A, Roberts I, Schierhout G; Mannitol for acute traumatic brain injury.; Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001049. [abstract]
  3. Okoromah CA, Afolabi BB; Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria.; Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004615. [abstract]
  4. Rezkalla SH; Contrast nephropathy.; Clin Med Res. 2003 Oct;1(4):301-4. [abstract]
  5. Koskela HO, Hyvarinen L, Brannan JD, et al; Responsiveness to three bronchial provocation tests in patients with asthma.; Chest. 2003 Dec;124(6):2171-7. [abstract]
  6. eFormulary from Multilex Drug Data file, accessed via www.doctors.net.uk (membership required)
AcknowledgementsEMIS is grateful to Dr Chloe Borton for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 379
Document Version: 1
DocRef: bgp25044
Last Updated: 18 Sep 2007
Review Date: 17 Sep 2008
















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