Mannitol (Systemic)

Name: Mannitol (Systemic)

If OVERDOSE is suspected

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Pronunciation

(MAN i tole)

Use Labeled Indications

Injection: Reduction of increased intracranial pressure associated with cerebral edema; reduction of increased intraocular pressure; promoting urinary excretion of toxic substances

Note: Although FDA-labeled indications, the use of mannitol for the prevention of acute renal failure and/or promotion of diuresis is not routinely recommended (Kellum 2008).

Genitourinary irrigation solution: Irrigation in transurethral prostatic resection or other transurethral surgical procedures

Administration

IV: Concentration and rate of administration depends on indication/severity, or may be adjusted to urine flow. For cerebral edema or elevated ICP, administer over 30 to 60 minutes. Inspect for crystals prior to administration. If crystals are present, redissolve by warming solution. Use filter-type administration set (≤5 micron) for infusion solutions containing mannitol ≥20% (WHO 2011). Do not administer with blood. Crenation and agglutination of red blood cells may occur if administered with whole blood.

Vesicant (at concentrations >5%); ensure proper catheter or needle position prior to and during IV infusion. Avoid extravasation of IV infusions.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Hurst 2004); elevate extremity.

Hyaluronidase: SubQ: Administer multiple 0.5 to 1 mL injections of a 15 units/mL solution around the periphery of the extravasation (Kumar 2003).

Irrigation: Administer using only the appropriate transurethral urologic instrumentation.

Storage

Injection: Should be stored at room temperature of 15°C to 30°C (59°F to 86°F); do not freeze. In concentrations ≥15%, crystallization may occur at low temperatures; do not use solutions that contain crystals. Heating in a hot water bath and vigorous shaking may be utilized for resolubilization. Cool solutions to body temperature before using.

Irrigation: Store at room temperature of 25°C (77°F); excursions permitted up to 40°C. Avoid excessive heat; do not warm above 150°F (66°C). Do not freeze.

(web3)