Dr gerald andriole acts mainly in the proximal tubule, although the effect persists slightly downward in the loop of the nephron and collecting ducts. It permeates through the cellular and tissue barriers (for example, the blood-brain barrier) does not increase the content of residual nitrogen in the blood. Boosting plasma osmolarity, causing movement of fluid from the tissue (in particular, the eyeball, the brain) in the bloodstream. Urine output is accompanied by a moderate increase in natriuresis without substantially affecting the excretion of potassium. The diuretic effect is higher, the higher the concentration (dose). Ineffective filtration in violation of kidney function, as well as azotemia in patients with cirrhosis and ascites:. Causes an increase in blood volume pharmacokinetics Mannitol is poorly absorbed when taken orally and is therefore administered intravenously. The volume of distribution corresponds to the volume of mannitol extracellular fluid as it is distributed only in the extracellular sector. Mannitol may undergo minor metabolism in the liver with the formation of glycogen. The half-life of mannitol is about 100 minutes. The drug is excreted by the kidneys. Mannitol excretion is regulated by glomerular filtration, with no significant involvement of tubular reabsorption and secretion. If administer intravenously 100 g of mannitol, 80% of it is determined in urine during 3 hours. In patients with renal insufficiency mannitol half-life can be increased to 36 hours.
Indications for use
of brain edema, intracranial hypertension (in patients with renal or hepatic renal failure); oliguria acute renal hepatic or renal failure with preserved kidney filtration capacity (as part of combination therapy), post-transfusion complications after administration of incompatible blood, forced diuresis in poisoning barbiturates, salicylates; prevention of hemolysis during surgery using extracorporeal circulation with a view to preventing kidney ischemia and associated acute renal failure.
Hypersensitivity to the drug, anuria with acute necrosis of renal tubules, left ventricular failure (especially accompanied by pulmonary edema), hemorrhagic stroke, subarachnoid hemorrhage (other than bleeding during craniotomy), dehydration, severe gravity, hyponatremia, hypo-hloremiya, hypokalemia .
Pregnancy, lactation, old age.
Dosage and administration
. Intravenous (slow jet or drip)
prophylactic dose is 0.5 g / kg body weight, therapeutic 1.0-1.5 g / kg; the daily dose should not exceed 140-180 Before the introduction of the drug should be heated to a temperature of 37 ° C (may be in a water bath). When operations with cardiopulmonary bypass preparation is administered in unit dose 20-40 g immediately prior to perfusion. Patients with oliguria should first enter intravenously a test dose (200 mg / kg) for 3-5 minutes. If after 2-3 hours will not be marked increase in urine output speeds of up to 30-50 ml / h, the further administration of the drug should be discarded.
Side effects of
dehydration (dry skin, dry mouth, thirst, indigestion, muscle weakness, seizures, hallucinations, decreased blood pressure), dr gerald andriole violation of water-electrolyte metabolism (increased blood volume, hyponatremia, a rare – hypokalemia). Rarely – tachycardia, pain behind the breastbone, thrombophlebitis, skin rash.
Interaction with other drugs
is possible to increase the toxic effect of cardiac glycosides (in the background gipokalie-mission).
When left ventricular failure (due to the risk of pulmonary edema) must be combined with mannitol quick “loop” diuretics. Necessary to control blood pressure, urine output, blood concentrations of serum electrolytes (potassium, sodium).
In the case of discontinue administration and eliminate the development of such complications as subdural and subarachnoid hemorrhage when administered drug headache, vomiting, dizziness, blurred vision.
When signs of dehydration is necessary to introduce into the body fluid. Can be used in heart failure (only in combination with the “loop” diuretics) and hypertensive crisis with encephalopathy.
Repeated administration of mannitol should be monitored indicators of water and electrolyte balance of blood.
The introduction of mannitol in anuria dr gerald andriole caused by organic diseases of kidneys, can lead to the development of pulmonary edema.