Page 157 - 2023 SMOG Digital

MANNITOL 20% Lactation? (Caution)
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 2 transport. Onset of action is 15-30 minutes
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
• Severe dehydration: (Do NOT use in under-resuscitated or hypotensive casualties)
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 climate. Will crystalize at low temperatures.
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Moderate to severe head injury, Patient Increased intracranial pressure (unlabeled
continuing to deteriorate or showing signs of dosing):
herniation despite adjustment to ventilation and IV:
starting hypertonic saline. • 0.25-1g/kg/dose
IV • Maintenance dose of 0.25-0.5g/kg IV q4-6hr
• 1g/kg IV bolus over <20 minutes. prn to maintain serum osmolality <300-320
• Follow with 0.25g/kg IVP q4hr mOsm/kg

Vital Functions Goal in Head Injury (Prevention
of secondary brain injury):
• Keep SBP >90mmHg, MAP >60mmHg, and
SaO 2 >93%. [(CPP=MAP–ICP) Minimal goal
CPP >60mmHg]
Note: Always have urinary catheter in place and
monitor output.

157