MANNITOL 15% W/ DEXTROSE 5% IN SODIUM CHLORIDE 0.45%
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Mannitol increases plasma osmolality, drawing water from tissues into the intravascular space via osmotic gradient, thereby reducing intracranial pressure and promoting diuresis. Dextrose provides caloric support. Sodium chloride provides electrolytes.
| Metabolism | Mannitol is minimally metabolized in the liver; mainly excreted unchanged by the kidneys. Dextrose is metabolized via glycolysis. Approximately 80% of mannitol is excreted in urine within 3 hours. |
| Excretion | Renal excretion of unchanged mannitol: 80-90% within 24 hours; dextrose is fully metabolized; sodium chloride is renally excreted. |
| Half-life | Mannitol: 0.5-1.5 hours in normal renal function; prolonged to 24-48 hours in anuria; dextrose: 1-2 hours; negligible for sodium chloride. |
| Protein binding | Mannitol: 0% (not bound to plasma proteins); dextrose: negligible; sodium chloride: not applicable. |
| Volume of Distribution | Mannitol: 0.2-0.5 L/kg, primarily extracellular; dextrose: ~0.2 L/kg; sodium chloride distributes in extracellular fluid. |
| Bioavailability | IV: 100% for all components; no oral bioavailability for mannitol (<10% absorbed). |
| Onset of Action | IV: Diuresis begins within 1-3 hours; osmotic effect on intracranial pressure within 15-30 minutes. |
| Duration of Action | IV: Diuresis lasts 4-8 hours; reduction of intracranial pressure lasts 3-8 hours, with possible rebound after 6-12 hours. |
| Molecular Weight | 182.17 |
Intravenous: 50 to 100 g (333-667 mL) initially, then 50 g (333 mL) every 4-6 hours to maintain urine output of 30-50 mL/hr. Administer as a 15% solution with dextrose 5% in 0.45% sodium chloride.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in anuria or severe renal impairment (GFR < 20 mL/min). Use with caution in oliguria; monitor urine output and renal function. |
| Liver impairment | No specific adjustment required; use with caution in severe hepatic impairment due to fluid and electrolyte balance concerns. |
| Pediatric use | 200 mg/kg to 2 g/kg as a 15% solution intravenously over 2-6 hours, not to exceed 60 g in 24 hours. Adjust based on urine output and clinical response. |
| Geriatric use | Start at lower end of dosing range; monitor renal function, fluid and electrolyte status due to age-related decline in renal function. |
| 1st trimester | Mannitol is a pregnancy category C drug. Use during first trimester only if clearly needed and potential benefit justifies potential risk to fetus. Animal studies have shown adverse effects (fetotoxicity) at high doses. Insufficient human data. |
| 2nd trimester | Use only if clearly needed. Monitor maternal fluid balance and electrolytes closely. Potential for fetal dehydration and electrolyte disturbances. |
| 3rd trimester | Use with caution near term due to risk of fetal fluid and electrolyte imbalances. May be used in specific clinical scenarios (e.g., cerebral edema) under careful monitoring. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Mannitol crosses the placenta. It distributes into fetal tissues and amniotic fluid. The degree of transfer can be significant, potentially causing fetal hyperosmolality and fluid shifts. |
| Breastfeeding | Mannitol is likely excreted into breast milk in small amounts, but due to poor oral absorption, systemic effects on infant are unlikely. However, maternal dehydration or electrolyte changes could affect milk composition. Use with caution, especially with prolonged or high-dose therapy. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | No evidence of teratogenicity in animal studies. Use in pregnancy only if clearly needed. Mannitol crosses placenta; fetal effects may include electrolyte disturbances and dehydration. Avoid in first trimester unless benefit outweighs risk. In second and third trimesters, monitor for maternal pulmonary edema and fetal distress. |
| Fetal Monitoring | Monitor serum electrolytes (Na, K, Cl, CO2), osmolality, renal function, fluid balance, urine output, and signs of pulmonary edema. In pregnancy, monitor fetal heart rate and uterine activity if used for conditions like oligohydramnios. Assess for volume overload in mother. |
| Fertility Effects | No known adverse effects on fertility in animal studies. In humans, no data regarding impact on fertility. Diuretics may alter menstrual cycle indirectly via fluid and electrolyte changes. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | fluid replacement |
| Serious Effects |
Anuria due to renal diseasePulmonary congestion or edemaActive intracranial bleeding (except during craniotomy)Severe dehydrationHypersensitivity to mannitol or any component
| Precautions | Monitor serum electrolytes, renal function, and fluid balance, Risk of pulmonary edema or congestive heart failure in patients with cardiac disease, Risk of acute kidney injury or renal tubular necrosis with excessive doses or prolonged use, May cause fluid and electrolyte disturbances (e.g., hyponatremia, hyperkalemia), Use with caution in patients with impaired renal function, Intravenous administration: avoid extravasation, use large vein, monitor for phlebitis |
| Food/Dietary | No known food interactions. However, patients may require sodium restriction depending on their condition. |
| Clinical Pearls | Monitor urine output and serum sodium closely; mannitol can cause osmotic diuresis leading to hypernatremia or hyponatremia depending on fluid status. Administer via central line due to high osmolality; extravasation causes tissue necrosis. Contraindicated in anuria, pulmonary edema, and intracranial bleeding. Use with caution in renal impairment and heart failure. |
| Patient Advice | This medication may increase urination; keep track of how much you urinate. · Report any chest tightness, difficulty breathing, or swelling. · You may experience dry mouth or thirst; maintain adequate fluid intake if allowed. · This solution is for intravenous use only; do not inject into muscle or under skin. |
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