title: Mannitol and other diuretics in severe neurotrauma.
abstract: Mannitol has replaced other diuretics as the agent of first choice for control of raised intracranial pressure (ICP) after brain injury. Mannitol should be given as a bolus intravenous infusion, over 10 to 30 mins, in doses ranging from 0.25 to 1.0 g/kg body weight. It may be given when high ICP is suspected, prior to computed tomography scanning, e.g., in patients who develop a fixed, dilated pupil or neurologic deterioration. This agent may also be used pre- or intraoperatively in patients with intracranial hematomas, and when high ICP is demonstrated in the ICU. It is more effective and safer when administered in bolus doses than as a continuous infusion. Mannitol may be safely used during the early resuscitation phase in hypovolemic patients with concomitant head injury, provided that plasma expanders and/or crystalloid solutions are given to correct the hypovolemia simultaneously. A Foley catheter should always be inserted when mannitol is used. Serum osmolality should be measured frequently after mannitol and maintained < 320 mOsm to avoid renal failure. Its beneficial effects and the rationale for its use are also reviewed.
mesh_terms: D001930:Brain Injuries / Q000188:drug therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004234:Diuretics, Osmotic / Q000494:pharmacology / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008353:Mannitol / Q000494:pharmacology / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol