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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Osmotic diuretics are agents that inhibit the reabsorption of solute and water by altering osmotic driving forces along the nephron. Osmotic diuretics include mannitol, glycerin, isosorbide and urea. Mannitol, a hexahydric alcohol related to mannose, with a molecular weight of 182 daltons, is most commonly used [15].
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
If ICP is dangerously high, (above 22mmHg) intravenous mannitol, an osmotic diuretic, may be given (Carney et al. 2016). Mannitol is a large-molecule sugar solution that rapidly increases the osmotic pressure of the blood. The increased osmotic pressure draws water from the interstitial space into the blood compartment, reducing interstitial cerebral oedema. Increases in blood volume are detected by the aortic and carotid baroreceptors and the atrial diastolic stretch receptors. Increased signals are sent to the vasomotor centre, indicating that the circulating volume is too high. Antidiuretic hormone is inhibited, and reabsorption of water by the kidneys ceases, causing an immediate diuresis. Mannitol is a potent osmotic diuretic, and patients may pass several litres of urine per hour. It is essential to maintain the patient’s electrolytes within normal range, particularly potassium, to prevent cardiac dysrhythmias as a complication of diuresis.
Hepatic failure
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Mannitol is contraindicated in severe renal disease (anuria), dehydration or active intracranial bleeding, and severe pulmonary oedema. Extravasation of mannitol causes inflammation and thrombophlebitis. Risks to the human fetus are unknown and, during pregnancy, potential benefits may outweigh the risks to the fetus.
Intra-dialytic intracranial pressure monitoring in a patient with lumbo-peritoneal shunt for idiopathic intracranial hypertension
Published in British Journal of Neurosurgery, 2023
W. B. Cato-Addison, L. Ferguson, R. D. Strachan, R. Clark, J. S. Murray, I. Moore
Although cerebral oedema is thought to be the underlying pathophysiological mechanism, DDS does not respond to mannitol or steroids. Only one case report showed improvement with intravenous mannitol.8 Other forms of dialysis such as continuous veno-veno haemofiltration (CVVH) and PD have not been shown to cause DDS although Lund et al attribute the magnitude of ICP rise primarily to the initial plasma urea levels.9 Fluid shift occurs at a slower rate with CVVH and therefore reduces the potential for a urea gradient across the blood–brain barrier to occur.3 Much of the evidence for this comes from patients with underlying renal disease who have been admitted to intensive care units for ICP monitoring following traumatic brain injury.10 The use of haemodialysis for these patients has been shown to raise ICP, which does not occur with CVVH.
Usefulness of mannitol challenge testing for diagnosing asthma in everyday clinical practice
Published in Journal of Asthma, 2020
Signe Knag Pedersen, Amalie S. Ustrup, Camilla B. Baarnes, Charlotte Suppli Ulrik
The mannitol challenge test was performed using a commercially available kit (Aridol/Osmohale) with pre-filled capsules of mannitol with different doses (0 mg to 160 mg). Mannitol was administered by inhalation in nine doses up to a cumulative dose of 635 mg (5, 10, 20, 40, 2 × 40, 4 × 40, 4 × 40, 4 × 40 mg). The first dose is 0 mg of mannitol, i.e. placebo, and the FEV1 measured post-dose is recorded as baseline FEV1 and used to calculate target level. A positive test was defined as s a 15% decline from baseline in FEV1, i.e. the PD15. However, if a 10% fall in FEV1 was observed between two consecutive doses, the test was terminated and considered positive. Otherwise, the test was stopped when a cumulative dose of 635 mg was reached, i.e. negative test. If the patient had a 10% drop between two consecutive doses of mannitol, the cumulative dose administered was recorded as PD15 (7). Patients were told not to take asthma medication, if prescribed any, 12 h before the test and smoking had to be avoided for at least 6 h before the test, if necessary, the test was rescheduled.
The leaky lung test: a pilot study using inhaled mannitol to measure airway barrier function in asthma
Published in Journal of Asthma, 2019
Steve Georas, Nicole Ransom, Sara Hillman, Sophia Eliseeva, Janelle Veazey, Timothy Smyth, Kim Le, Jon Meddings
We reasoned that a direct method to measure airway epithelial barrier function would be useful, and envisioned a test in which subjects inhale an inert compound followed by measurements of its absorption into the blood stream. We were inspired by studies of intestinal permeability, which measure the absorption of swallowed lactulose and mannitol [17,18]. To be a useful test agent, the inhaled compound would need to: (i) be safe and well tolerated, (ii) translocate across epithelial barriers via paracellular routes, and (iii) not undergo extensive metabolism once absorbed into the bloodstream. Mannitol fulfills each of these criteria. First, mannitol is a widely used food additive generally recognized as safe by the US Food and Drug Administration (FDA). Intravenous mannitol is used therapeutically to induce a hyperosmolar state and reduce cerebral edema, whereas inhaled mannitol is an alternative to methacholine for bronchoprovocation studies [19,20]. Second, mannitol is commonly used to assay epithelial monolayer integrity in vitro, since it diffuses paracellularly between cells when intercellular junctions are disrupted. Third, mannitol undergoes very little metabolism and is excreted almost entirely unchanged by the kidneys. Here we report preliminary studies comparing the absorption of inhaled mannitol in healthy subjects and mild asthmatics.