Where the kidney is concerned, how much mannitol is too much?
OBJECTIVE
To report a case of mannitol-induced acute renal failure (ARF).


METHODS
A 31-year-old woman who had been on long-term warfarin therapy for atrial fibrillation was admitted to the hospital with hemoptysis. Following reversal of her anticoagulation, she had a tonic-clonic seizure nine days after admission. An emergency computed tomography scan revealed cerebral edema, which was initially treated with hyperventilation and steroids. Two days later, a repeat scan showed progression of the cerebral edema with midline shift. Mannitol 550 g was infused over the next 28 hours, precipitating ARF. Despite prompt hemodialysis to reverse the renal failure, the patient died. This case of apparent mannitol-induced ARF illustrates several pathophysiologic effects of this agent.


CONCLUSIONS
Case reports in the literature discussing mannitol-induced ARF are reviewed and compared. A relationship between dose and ARF and its reversal with hemodialysis is postulated.


CONCLUSIONS
It is likely that sufficient doses of mannitol may lead to ARF. Limitation of dose may prevent and treatment with hemodialysis may reverse ARF in these instances.
Rabetoy
G M
GM
Department of Internal Medicine, Naval Hospital, San Diego, CA.
Fredericks
M R
MR
Hostettler
C F
CF
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D001929:Brain Edema / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects*; D006435:Renal Dialysis
D008353:Mannitol