MANNITOL 15% W/ DEXTROSE 5% IN SODIUM CHLORIDE 0.45%
Clinical safety rating: safe
No 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Mannitol likely excreted in breast milk due to low molecular weight. No M/P ratio available. Use with caution in lactating women; consider risk of infant dehydration or electrolyte imbalance. May suppress lactation due to diuretic effect. |
| 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. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | fluid replacement |
| Serious Effects |
["Anuria or severe renal impairment","Pulmonary edema or congestive heart failure","Active intracranial bleeding (except during craniotomy)","Dehydration or hypovolemia","Known hypersensitivity 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"] |
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| 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. |