title: Life-Threatening Mannitol-Induced Hyperkalemia in Neurosurgical Patients.
abstract: BACKGROUND
  Mannitol is the most commonly used intraoperative hypertonic solution in patients undergoing craniotomy. However, its use has been reported to be associated with hyperkalemia, which can occasionally be life threatening.
  
  
  BACKGROUND
  In this report, we discuss the case of a patient who had intraoperative cardiac arrest secondary to mannitol-induced hyperkalemia during a craniotomy for tumor resection. In addition, we provide a comprehensive review of the literature concerning similar cases previously reported, as well as a discussion of the pathophysiology of mannitol-induced hyperkalemia. Review of the literature suggests that patients prone to this phenomenon are young and healthy individuals with normal preoperative and postoperative cardiopulmonary and renal functions. The literature also suggests that the total dose of mannitol, as well as its rate of infusion, may play a role in the development of this phenomenon.
  
  
  CONCLUSIONS
  Knowledge of the existence of mannitol-induced hyperkalemia is paramount for the neurosurgeon and the anesthesiologist, because early treatment with insulin and calcium can quickly restore normal cardiac rhythm and prevent intraoperative death.
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fanous
authors.affiliation: Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Anesthesiology and Pain Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Tick
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
authors.forename: Eugene Y
authors.initials: EY
authors.lastname: Gu
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York, USA. Electronic address: robert.fenstermaker@roswellpark.org.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fenstermaker
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology; D003399:Craniotomy / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D006982:Hypertonic Solutions / Q000009:adverse effects*; D008297:Male; D008353:Mannitol / Q000009:adverse effects*
chemical_list: D006982:Hypertonic Solutions; D008353:Mannitol
keywords: Adverse event; Cardiac arrest; Craniotomy; Hyperkalemia; Intraoperative complication; Mannitol infusion