title: Acute renal failure following massive mannitol infusion.
abstract: Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 +/- 439 g (mean +/- SD) during a time period of 58 +/- 28 h. The infusion rate was 0.25 +/- 0.02 g/kg/h. The onset of acute renal failure was detected 48 +/- 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 +/- 11 mEq/l), and hyperosmolality (osmolar gap 70 +/- 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension - one of them while recovering - on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.
authors.affiliation: Department of Nephrology, Hospital Xeral de Vigo, Servicio Galego de Saúde, Spain. javier.perez.perez@sargas.es
authors.forename: Angel J
authors.initials: AJ
authors.lastname: Pérez-Pérez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pazos
authors.forename: José
authors.initials: J
authors.lastname: Sobrado
authors.forename: Luis
authors.initials: L
authors.lastname: Gonzalez
authors.forename: Argimiro
authors.initials: A
authors.lastname: Gándara
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D004234:Diuretics, Osmotic / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced; D008297:Male; D008353:Mannitol / Q000008:administration & dosage* / Q000009:adverse effects*; D009994:Osmolar Concentration; D006435:Renal Dialysis; D014556:Urine / Q000166:cytology
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol