Page 145 - 2026 SMOG

MANNITOL (20%)
Class/Mechanism of Action
• Osmotic Diuretic
Increases osmotic pressure of glomerular filtrate. This reduces kidney reabsorption of water
and electrolytes and increases urinary output. Decreases cerebral blood volume and intracranial
pressure (ICP) while increasing cerebral blood flow and O transport.
2
˚ Onset of action—Reduction of ICP: 15–30min, Diuresis: 1–3hr
Indications
• Labeled Indications
˚ Reduction of increased ICP secondary to cerebral edema
˚ Reduction of elevated intraocular pressure
˚ Urinary excretion of toxic substances
Contraindications
• Hypersensitivity to mannitol or any component of the formulation
• Active intracranial bleeding
• Pulmonary congestion and edema
• Severe renal disease or renal dysfunction after mannitol use
• SBP <110
• Any active bleeding
Adverse Reactions/Precautions
• Chest pain, CHF, tachycardia, circulatory overload (with rapid administration), peripheral edema
• Headache, seizure
• Fluid and electrolyte imbalance, dehydration, and hypovolemia
• Keep in a temperature-controlled environment. Will crystallize at low temperatures
• Repeated use may worsen ICP
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Moderate to Severe Head Injury/Patient Increased Intracranial Pressure
Continuing to Deteriorate or Showing (Off-Label use)
Signs of Herniation Despite Adjustment to • IV/IO
Ventilation and Starting Hypertonic Saline ˚ 0.25–1g/kg over 20–30min
• IV/IO ■ Repeat prn to maintain serum
˚ 1g/kg IV bolus over 20min osmolality <320mOsm/kg
Follow with 0.5g/kg q3hr
˚
Note: If available, have a urinary catheter in
place and monitor output
Note: 3% Hypertonic Saline is preferred over
Mannitol

2026 Standard Medical Operating Guidelines (SMOG) • 137