Mannitol

Provider Level

RN/Paramedic

Class

Osmotic diuretic

Mechanism of Action

Elevates blood plasma osmolarity, drawing water from tissues (including the brain) into the interstitial fluid and plasma, thereby decreasing intracranial pressure and cerebral edema.

Indications

Increased intracranial pressure, severe head injury with signs of impending herniation.

Contraindications

Severe renal disease, active intracranial bleeding (except during operative procedures), severe dehydration, established pulmonary edema.

Routes

IV, IO

Onset / Duration

Onset: 15 to 30 minutes. Duration: 1 to 6 hours.

Adverse Effects

Hypotension, pulmonary edema, fluid and electrolyte imbalances, headache, nausea, vomiting, tachycardia.

Precautions & Interactions

May cause transient intravascular volume expansion leading to congestive heart failure or pulmonary edema in susceptible patients. Monitor vital signs and neurological status continuously.

Special Considerations

Must be administered using an in-line filter because it is highly susceptible to crystallization. If crystals are present, they must be dissolved by warming before administration. Do not administer if crystals remain undissolved.