MANNITOL 5% W/ DEXTROSE 5% IN SODIUM CHLORIDE 0.12%
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Mannitol is an osmotic diuretic that increases plasma osmolality, drawing water from extravascular spaces (e.g., brain, eyes) into the intravascular compartment and enhancing water excretion by the kidneys. Dextrose provides caloric supplementation, and sodium chloride provides electrolytes to maintain tonicity.
| Metabolism | Mannitol is not significantly metabolized; it is freely filtered by the glomeruli and excreted unchanged in urine. Dextrose is metabolized via glycolysis and oxidative phosphorylation. Sodium chloride dissociates into ions that are handled by renal tubular transport. |
| Excretion | Renal: >90% mannitol excreted unchanged in urine; dextrose is fully reabsorbed or metabolized; sodium chloride is handled by renal tubules. |
| Half-life | Mannitol: 0.25–1.5 hours (approximately 15–90 minutes); prolonged in renal impairment. Dextrose: <30 minutes (endogenous regulation). |
| Protein binding | Mannitol: 0% (not bound); dextrose: negligible; sodium: minimal. |
| Volume of Distribution | Mannitol: ~0.3–0.7 L/kg; distributes primarily in extracellular fluid; does not cross cell membranes significantly. |
| Bioavailability | Intravenous: 100% for all components. |
| Onset of Action | Intravenous: Diuresis within 1–3 hours (mannitol); dextrose and sodium chloride effects immediate but variable. |
| Duration of Action | Mannitol: 4–6 hours (diuresis); dextrose: duration depends on glucose metabolism and insulin response. |
| Molecular Weight | 182.17 |
Intravenous infusion. For osmotic diuresis: 50-100 g (1000-2000 mL of this solution) over 1-2 hours, total dose not exceeding 200 g/day. For reduction of intracranial pressure: 1.5-2 g/kg as a 20-25% solution given IV over 30-60 minutes. This 5% solution is not typically used for ICP reduction due to dilution.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in anuria due to severe renal disease or severe renal impairment (GFR <10 mL/min). Caution in mild to moderate impairment; monitor serum osmolality and electrolytes. No specific GFR-based dose adjustment established. |
| Liver impairment | No specific adjustment for Child-Pugh class. Caution in severe hepatic impairment due to risk of fluid overload and electrolyte disturbances. |
| Pediatric use | For osmotic diuresis: 2 g/kg IV over 1-2 hours as a 15-20% solution. For cerebral edema: 1-2 g/kg IV over 30-60 minutes as a 20-25% solution. Not typically using this 5% formulation for these indications. |
| Geriatric use | Use with caution due to age-related decline in renal function. Monitor renal function, fluid balance, and electrolytes. Initiate at low end of dosing range. |
| 1st trimester | Used as an osmotic diuretic for maternal indications; may cause fetal dehydration and electrolyte imbalance. Use only if clearly needed. |
| 2nd trimester | Risk of fetal dehydration and electrolyte disturbances; monitor maternal fluid balance. Use only if benefits outweigh risks. |
| 3rd trimester | May cause fetal dehydration, electrolyte imbalance, and potential for fetal hyponatremia. Avoid near term if possible. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Crosses placenta; may cause fetal osmotic diuresis and electrolyte shifts. |
| Breastfeeding | Excreted into breast milk in small amounts; unlikely to cause adverse effects in infants due to poor oral absorption. Monitor infant for diarrhea or electrolyte disturbances if high maternal doses used. |
| Lactation Rating | L2 – Safer |
| Teratogenic Risk | Pregnancy Category C. Mannitol and dextrose combinations are generally considered low risk for teratogenicity. Mannitol is an osmotic diuretic that does not cross the placenta significantly at therapeutic doses. Dextrose is a normal constituent of maternal and fetal blood; however, hyperglycemia from dextrose infusion may be associated with fetal hyperinsulinism and macrosomia if maternal glucose is poorly controlled. No specific teratogenic effects have been reported for this combination. Benefit-risk assessment is required. |
| Fetal Monitoring | Monitor maternal serum electrolytes (sodium, potassium, chloride), serum osmolarity, fluid balance (intake/output), renal function (serum creatinine, BUN), and blood glucose levels. Fetal monitoring (non-stress test or biophysical profile) is indicated if maternal hyperglycemia or fluid overload occurs. Assess for signs of pulmonary edema in mother. |
| Fertility Effects | No known direct effects on fertility. Mannitol and dextrose do not affect spermatogenesis or ovulation at therapeutic doses. Underlying conditions requiring this therapy (e.g., cerebral edema, renal failure) may indirectly impact fertility. |
■ FDA Black Box Warning
None
| Common Effects | fluid replacement |
| Serious Effects |
AnuriaCongestive heart failure (severe)Pulmonary edemaActive intracranial bleeding (except during craniotomy)Severe dehydrationHypersensitivity to mannitol or any excipient
| Precautions | May cause circulatory overload, pulmonary edema, or congestive heart failure in patients with compromised cardiac function. Monitor serum electrolytes, osmolality, and renal function. Use with caution in patients with anuria, severe renal impairment, or active intracranial bleeding (risk of expansion). Avoid extravasation (can cause tissue necrosis). Rapid administration may cause headache, nausea, or blurred vision. |
| Food/Dietary | No specific food interactions. However, avoid high-sodium foods to prevent exacerbation of hypernatremia. |
| Clinical Pearls | Monitor serum sodium and osmolality closely due to risk of hypernatremia and hyperosmolality; contraindicated in anuria, severe pulmonary edema, and intracranial hemorrhage. Use with caution in patients with renal impairment or congestive heart failure. |
| Patient Advice | Report any swelling, shortness of breath, or rapid weight gain. · Do not consume additional salt in diet while receiving this infusion. · Inform healthcare provider if you have kidney problems or heart failure. · This medication may cause increased urination; keep track of fluid intake and output. |
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