Used to promote diuresis for the prevention and/or treatment of the oliguric phase of acute renal failure, which may occur after massive hemorrhage, trauma, shock, burns, transfusion reactions caused by mismatched blood, or major surgery before there is evidence of tubular necrosis or multiple vascular thrombosis.
Has been used to reduce nephrotoxicity caused by amphotericin B.
Has no effect and may be harmful if used after tubular necrosis and irreversible renal failure become established.
Reduction of Intracranial Pressure
Used prior to and during neurosurgery to reduce greatly increased intracranial pressure and for the treatment of cerebral edema. Also may be used for early treatment of cerebral edema in patients with diabetic ketoacidosis or in those in hypoglycemic coma who fail to respond to increases of blood glucose concentrations.
Reduction of Intraocular Pressure
Used to reduce elevated intraocular pressure (IOP) when the pressure cannot be lowered by other means. Especially useful for treating acute episodes of angle-closure, absolute, or secondary glaucoma and for lowering IOP prior to intraocular surgery.
Urinary Excretion of Toxins
Used alone or with other diuretics (e.g., furosemide, ethacrynic acid) to promote the urinary excretion of toxins (e.g., aspirin or other salicylates, some barbiturates, bromides, imipramine) as an adjunct to usual treatment regimens in patients with severe intoxications.
Transurethral Prostatic Resection and Transurethral Prostatectomy
Used as an irrigating solution in transurethral prostatic resection to minimize the hemolytic effects of water, the entrance of hemolyzed blood into the circulation, and the resulting hemoglobinemia which is considered a major factor in producing serious renal complications.
Also has been administered IV before, during, and after transurethral prostatectomy† to maintain urine output, promote rapid excretion of absorbed irrigants, and reduce the need for postoperative irrigation.
Hyperuricemia
Has been used to promote excretion of uric acid and prevent hyperuricemia and/or uric acid nephropathy† in patients who develop uricemia following chemotherapy or radiation therapy for leukemia or lymphoma.
Ciguatera Toxicity
Has been used as initial therapy, in combination with other supportive therapy, to reverse neurologic and neurosensory manifestations as well as GI manifestations of ciguatera fish poisoning†.
Edema and Ascites
Has been used alone or in conjunction with other diuretics to promote diuresis for the supportive treatment of edema and ascites† of nephrotic, cirrhotic, or cardiac origin.
Dosage and Administration
General
Dosage, concentration of solution, and rate of administration vary with the condition being treated and the patient’s fluid requirements, urinary output, and response to the drug.
Do not administer drug until adequacy of patient's renal function and urine flow have been established.
Replace fluids, plasma, blood, and electrolytes prior to initiating therapy in patients with shock with oliguria and rising BUN.
Administration
Administer mannitol injection IV. Administer sorbitol-mannitol irrigation solution by transurethral instillation.
IV Administration
For drug compatibility information, see Compatibility under Stability.
Administer by IV infusion using an administration set with a filter.
When used in surgical procedures to prevent oliguric acute renal failure, administration may be initiated before or immediately following surgery and may be continued postoperatively.
When used preoperatively to reduce IOP, administer 1–1.5 hours prior to surgery in order to achieve maximum reduction of pressure before surgery.
Test Dose
Administer a test dose to patients with marked oliguria or suspected inadequate renal function to establish renal response before therapy is initiated.
A response is considered adequate if at least 30–50 mL of urine per hour is excreted over the next 2–3 hours.
If an adequate response is not attained, a second test dose may be given.
If a satisfactory response is not obtained after the second test dose, reevaluate patient, and mannitol should not be used.
Rate of Administration
Test dose in adults and children >12 years of age: Infuse over a period of 3–5 minutes to produce urine flow of ≥30–50 mL/hour.
Treatment of oliguria in adults: Infuse over 90 minutes to several hours.
Cerebral or ocular edema in children >12 years of age: Usually, infuse over 30–60 minutes.
Reduction of intracranial or IOP in adults: Usually, infuse over 30–60 minutes.
Edema and ascites† in adults and children >12 years of age: Has been infused over 2–6 hours.
Transurethral Irrigation
Sorbitol-mannitol irrigation solution is for urologic irrigation only; do not use for injection.
Administer only by transurethral instillation using appropriate and disposable urologic instrumentation.
Placing the flexible irrigation container >60 cm above the operating table may increase intravascular absorption of irrigation solution.
Dosage
Pediatric Patients
Oliguric Acute Renal Failure
Test dose
IV
Children >12 years of age: 0.2 g/kg or 6 g/m2 as a single dose.
Therapeutic purpose
IV
Children >12 years of age: 2 g/kg or 60 g/m2.
Cerebral or Ocular Edema
IV
Children >12 years of age: 2 g/kg or 60 g/m2 administered as a 15 or 20% solution.
Urinary Excretion of Toxins
IV
Children >12 years of age: 2 g/kg or 60 g/m2 administered as a 5 or 10% solution as needed.
Edema and Ascites
IV
Children >12 years of age: 2 g/kg or 60 g/m2 administered as a 15 or 20% solution.†
Adults
Usual Dosage
IV
20–100 g administered in a 24-hour period.
Test Dose
IV
Approximately 0.2 g/kg or 12.5 g infused IV as a 15 or 20% solution (usually 100 or 75 mL of a 15 or 20% solution, respectively).
Oliguric Acute Renal Failure
Prevention
IV
50–100 g as a 5, 10, or 15% solution. Generally, a concentrated solution is administered initially followed by a 5 or 10% solution.
Treatment of Oliguria
IV
100 g infused IV as a 15 or 20% solution.
Management of Nephrotoxicity Associated with Amphotericin B
IV
12.5 g administered immediately before and after each dose of amphotericin B.
Reduction of Intracranial Pressure
IV
Usually, 0.25 g/kg administered not more frequently than every 6–8 hours will achieve a maximum reduction of intracranial pressure. Alternatively, 1.5–2 g/kg infused IV as a 15, 20, or 25% solution.
A satisfactory reduction in intracranial pressure can be achieved with an osmotic gradient between blood and CSF of approximately 10 mOsmol.
Reduction of IOP
IV
Usually, 1.5–2 g/kg infused IV as a 15, 20, or 25% solution.
Some clinicians have recommended as little as 1 g or as much as 3.2 g/kg infused IV as a 15, 20, or 25% solution.
Urinary Excretion of Toxins
IV
In general, maintain a urinary output of >100 mL/hour, but preferably 500 mL/hour, and a positive fluid balance of 1–2 L.
Initially, 25 g, followed by infusion of a solution at a rate that will maintain a urinary output of ≥100 mL/hour.
In barbiturate poisoning, initially 0.5 g/kg, followed by administration of a 5 or 10% solution at a rate to maintain the desired urine output.
Alternatively, administer 1 L of a 10% solution during the first hour. Measure urine volume and pH and calculate cumulative fluid balance at the end of the first hour and subsequent 2-hour periods. If positive fluid balance is 1–2 L, administer 1 L of a 10% solution over the next 2 hours. If positive fluid balance is <1 L, replace mannitol with 1 L of (1/6) M sodium lactate over the next 2 hours (if urine pH <7) or 1 L of 0.9% sodium chloride over 2 hours (if urine pH >7). If the positive fluid balance is >2 L, administer 10% mannitol at the slowest possible rate. IV administration of furosemide recommended if the positive fluid balance >2.5 L.
Transurethral Prostatic Resection
Urogenital Irrigation
Administer a sufficient volume of sorbitol-mannitol irrigation solution; volume determined at the discretion of clinician.
Hyperuricemia
IV
50 g/m2 has been given in 24 hours.†
Ciguatera Toxicity
IV
1 g/kg.†
Edema and Ascites
IV
100 g infused IV as a 10–20% solution.†
Special Populations
Geriatric Patients
Select dosage with caution, starting at the low end of the dosing range, because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.
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