R M Sharma1, R Setlur2, M N Swamy3. 1. Senior Advisor (Anaesthesiology and Critical Care), 5 Air Force Hospital, C/o 99 APO. 2. Senior Advisor (Anaesthesiology and Critical Care), AH (R & R), Delhi Cantt. 3. Senior Advisor (Neuro-Surgery), Command Hospital (Central Command), Lucknow.
Abstract
BACKGROUND: The effectiveness of mannitol as an osmotherapeutic agent has never been subjected to a controlled clinical trial against placebo. Excessive use of mannitol in brain trauma patients can result in hyperosmolar states, hypernatremia and renal failure. This prospective study was conducted to evaluate the institutional protocol of using mannitol and assess its effects on serum osmolality. METHOD:Thirty patients with brain injury were included in the study. All the patients were given 100 mL of 20% mannitol three times a day as bolus infusion over 20-30 minutes. Serum osmolality was measured at 12 hourly intervals using Fiske osmometer. Mannitol administration was stopped whenever serum osmolality reached ≥ 320 mOsmol/Kg H2O. The total dose and duration of mannitol used to reach target osmolality of ≥ 320 mOsmol/Kg H2O was recorded. RESULTS: On 33% of all occasions, the patients had a serum osmolality which was in excess of the desired values (i.e. ≥ 320 mOsmol/Kg H2O). This indicates that the standard protocol of administering 20% mannitol 100 mL three times a day for more than 48 hours is perhaps excessive. CONCLUSION: The mannitol therapy should be guided by 12 hourly measurement of serum osmolality. Mannitol should be used for 48 hours only if facilities for measuring serum osmolality are not available.
RCT Entities:
BACKGROUND: The effectiveness of mannitol as an osmotherapeutic agent has never been subjected to a controlled clinical trial against placebo. Excessive use of mannitol in brain traumapatients can result in hyperosmolar states, hypernatremia and renal failure. This prospective study was conducted to evaluate the institutional protocol of using mannitol and assess its effects on serum osmolality. METHOD: Thirty patients with brain injury were included in the study. All the patients were given 100 mL of 20% mannitol three times a day as bolus infusion over 20-30 minutes. Serum osmolality was measured at 12 hourly intervals using Fiske osmometer. Mannitol administration was stopped whenever serum osmolality reached ≥ 320 mOsmol/Kg H2O. The total dose and duration of mannitol used to reach target osmolality of ≥ 320 mOsmol/Kg H2O was recorded. RESULTS: On 33% of all occasions, the patients had a serum osmolality which was in excess of the desired values (i.e. ≥ 320 mOsmol/Kg H2O). This indicates that the standard protocol of administering 20% mannitol 100 mL three times a day for more than 48 hours is perhaps excessive. CONCLUSION: The mannitol therapy should be guided by 12 hourly measurement of serum osmolality. Mannitol should be used for 48 hours only if facilities for measuring serum osmolality are not available.
Authors: P Horn; E Münch; P Vajkoczy; P Herrmann; M Quintel; L Schilling; P Schmiedek; L Schürer Journal: Neurol Res Date: 1999-12 Impact factor: 2.448
Authors: Susan L Bratton; Randall M Chestnut; Jamshid Ghajar; Flora F McConnell Hammond; Odette A Harris; Roger Hartl; Geoffrey T Manley; Andrew Nemecek; David W Newell; Guy Rosenthal; Joost Schouten; Lori Shutter; Shelly D Timmons; Jamie S Ullman; Walter Videtta; Jack E Wilberger; David W Wright Journal: J Neurotrauma Date: 2007 Impact factor: 5.269
Authors: A I Qureshi; J I Suarez; A Bhardwaj; M Mirski; M S Schnitzer; D F Hanley; J A Ulatowski Journal: Crit Care Med Date: 1998-03 Impact factor: 7.598
Authors: J I Suarez; A I Qureshi; A Bhardwaj; M A Williams; M S Schnitzer; M Mirski; D F Hanley; J A Ulatowski Journal: Crit Care Med Date: 1998-06 Impact factor: 7.598