Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline.
OBJECTIVE
Hyperosmolar therapy is one of the core medical treatments for brain edema and intracranial hypertension, but controversy exists regarding the use of the most common agents, mannitol, and hypertonic saline. This article describes the relative merits and adverse effects of these agents using the best available clinical evidence.


RESULTS
Mannitol is effective and has been used for decades in the treatment of traumatic brain injury, but it may precipitate acute renal failure if serum osmolarity exceeds 320 mOsm/L. Hypertonic saline appears to be safe, and serum sodium has been elevated to as high as 180 mEq/L in clinical settings without significant neurologic, cardiac, or renal injury. In small comparative trials both agents are effective and no clinically significant difference has been noted, but a properly powered trial has not yet been performed.


CONCLUSIONS
Both mannitol and hypertonic saline are effective and have an acceptable risk profile for use in the treatment of elevated intracranial pressure secondary to brain edema.
Weill Cornell Medical College, Department of Neurology and Neuroscience, 525 East 68th Street, F-610, New York, NY 10065, USA. mfink@med.cornell.edu
Matthew E
ME
Fink
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D001929:Brain Edema / Q000150:complications / Q000628:therapy; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008353:Mannitol / Q000009:adverse effects / Q000627:therapeutic use*; D009994:Osmolar Concentration; D017410:Practice Guidelines as Topic; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*
D012462:Saline Solution, Hypertonic; D008353:Mannitol