Mannitol injection

Mannitol injection is a hypertonic preparation. It produces direct pharmacological effects through hypertonic dehydration, eliminates brain edema, reduces brain water content, and reduces intracranial pressure. The main ingredient, mannitol, is a monosaccharide that is not metabolized in the body. After glomerular filtration, it is rarely reabsorbed in the renal tubules, playing an osmotic diuretic role. 1. Tissue dehydration. Increasing plasma osmotic pressure causes water in tissues (including eyes, brain, cerebrospinal fluid, etc.) to enter the blood vessels, thereby reducing tissue edema, reducing intraocular pressure, intracranial pressure, and cerebrospinal fluid volume and pressure. 1g of mannitol can produce an osmotic concentration of 5.5mOsm. Injecting 100g of mannitol can transfer 2000ml of intracellular water to the extracellular space and excrete 50g of urinary sodium. 2. Diuretic effect. The diuretic mechanism of mannitol is divided into two aspects: ① Mannitol increases blood volume and promotes the secretion of prostaglandin I2, thereby dilating renal blood vessels and increasing renal blood flow, including renal medullary blood flow. The glomerular afferent arterioles dilate, the glomerular capillary pressure increases, and the cortical glomerular filtration rate increases. ② After glomerular filtration, very little (10%) of this drug is reabsorbed by the renal tubules, so it can increase the osmotic concentration of the renal tubular fluid and reduce the reabsorption of water, Na, Cl-, K, Ca2, Mg2 and other solutes by the renal tubules. Since the renal tubular fluid flow increases after the infusion of mannitol, when certain drugs and poisons are poisoned, the concentration of these substances in the renal tubules decreases, the toxicity to the kidneys is reduced, and the excretion through the kidneys is accelerated. Glucose is one of the main sources of heat for the human body. Each gram of glucose can produce 4 kcal (16.7 kJ) of heat energy to supplement heat. In addition, it also has a certain tissue dehydration effect. Sodium and chloride are important electrolytes in the body, mainly present in the extracellular fluid, and play a very important role in maintaining the normal volume and osmotic pressure of blood and extracellular fluid in the human body. Normal serum sodium concentration is 135-145 mmol/L, accounting for 92% of plasma cations and 90% of total osmotic pressure, so the amount of plasma sodium plays a decisive role in osmotic pressure. Normal serum chloride concentration is 98-106 mmol/L. The human body mainly regulates through the hypothalamus, posterior pituitary and kidneys to maintain the stability of body fluid volume and osmotic pressure.

The main ingredient of this product and its chemical name: D-mannitol.

1. Tissue dehydration drugs. Used to treat brain edema caused by various reasons, reduce intracranial pressure, and prevent brain herniation. 2. Reduce intraocular pressure. It can effectively reduce intraocular pressure and is used when other intraocular pressure-lowering drugs are ineffective or for preparation before intraocular surgery. 3. Osmotic diuretics. Used to identify oliguria caused by prerenal factors or acute renal failure. It can also be used to prevent acute tubular necrosis caused by various reasons. 4. As an auxiliary diuretic measure to treat nephrotic syndrome and ascites caused by cirrhosis, especially when accompanied by hypoproteinemia. 5. For overdose of certain drugs or poisoning by toxins (such as barbiturates, lithium, salicylates and bromides, etc.), this drug can promote the excretion of the above substances and prevent renal toxicity. 6. As an irrigation agent, it is used for transurethral prostatectomy. 7. Preoperative bowel preparation.

1. Common dosage for adults: (1) Diuresis. Common dosage is 1-2 g/kg based on body weight. Generally, 250 ml of 20% solution is intravenously dripped, and the dosage is adjusted to maintain urine output at 30-50 ml per hour. (2) Treatment of cerebral edema, intracranial hypertension and glaucoma. 0.25-2 g/kg based on body weight, prepared as 15%-25% concentration and dripped intravenously within 30-60 minutes. When the patient is weak, the dosage should be reduced to 0.5 g/kg. Closely follow up renal function. (3) Differentiate between prerenal oliguria and renal oliguria. 0.2 g/kg based on body weight, dripped intravenously at 20% concentration within 3-5 minutes. If the urine output per hour is still less than 30-50 ml after 2-3 hours after medication, try it once more at most. If there is still no response, the drug should be discontinued. Patients with existing heart function impairment or heart failure should use it with caution or should not use it. (4) Prevention of acute tubular necrosis. First, give 12.5-25g, intravenous drip within 10 minutes. If there are no special circumstances, give 50g, intravenous drip within 1 hour. If the urine volume can be maintained at more than 50ml per hour, the 5% solution can be continued to be dripped; if it is ineffective, stop the drug immediately. (5) Treatment of drug and poison poisoning. 50g is dripped intravenously as a 20% solution, and the dose is adjusted to maintain the urine volume at 100-500ml per hour. (6) Bowel preparation. 4-8 hours before surgery, 1000ml of 10% solution is taken orally within 30 minutes. 2. Common dosage for children: (1) Diuresis. According to body weight 0.25-2g/kg or body surface area 60g/m2, it is intravenously dripped within 2-6 hours as a 15%-20% solution. (2) Treatment of cerebral edema, intracranial hypertension and glaucoma. 1-2 g/kg of body weight or 30-60 g/m2 of body surface area, intravenous drip at 15%-20% concentration within 30-60 minutes. When the patient is weak, the dose is reduced to 0.5 g/kg. (3) Differentiate between prerenal oliguria and renal oliguria. 0.2 g/kg of body weight or 6 g/m2 of body surface area, intravenous drip at 15%-25% concentration for 3-5 minutes. If there is no significant increase in urine volume 2-3 hours after medication, it can be used again. If there is still no response, it is not used again. (4) Treatment of drug and poison poisoning. 2 g/kg of body weight or 60 g/m2 of body surface area, intravenous drip at 5%-10% solution.

1. Water and electrolyte disorders are the most common. (1) Rapid intravenous injection of large amounts of mannitol can cause accumulation of mannitol in the body, rapid and large increase in blood volume (especially in acute and chronic renal failure), leading to heart failure (especially in cases of heart damage), dilutional hyponatremia, and occasionally hyperkalemia; (2) Inappropriate excessive diuresis leads to decreased blood volume and aggravates oliguria; (3) Large amounts of intracellular fluid transferred to the extracellular space can cause tissue dehydration and central nervous system symptoms. 2. Chills and fever. 3. Difficulty urinating. 4. Thrombophlebitis. 5. Mannitol extravasation can cause tissue edema and skin necrosis. 6. Allergies cause rash, urticaria, dyspnea, and anaphylactic shock. 7. Dizziness and blurred vision. 8. Hyperosmosis causes thirst. 9. Osmotic nephropathy (or mannitol nephropathy), mainly seen in large-dose rapid intravenous infusion. The mechanism has not been fully elucidated, but it may be related to mannitol causing excessive increase in tubular fluid osmotic pressure, leading to tubular epithelial cell damage. Pathological manifestations include swelling of tubular epithelial cells and vacuolation. Clinically, urine volume decreases and even acute renal failure occurs. Osmotic nephropathy is common in elderly patients with reduced renal blood flow, hyponatremia, and dehydration.

1. Anuric patients diagnosed with acute tubular necrosis, including those who do not respond to mannitol trials, because mannitol accumulation causes increased blood volume and increases the burden on the heart. 2. Severe water loss. 3. Active intracranial bleeding, because volume expansion aggravates bleeding, except during intracranial surgery. 4. Acute pulmonary edema, or severe pulmonary congestion.

Precautions for children: Precautions during pregnancy and lactation: (1) Mannitol can pass through the placental barrier. (2) It is not clear whether it can be secreted through breast milk. Precautions for the elderly: Elderly people are more likely to suffer from kidney damage when using this drug, and the chance of kidney damage increases with age. Appropriately control the dosage.

1. It can increase the toxicity of digitalis and is related to hypokalemia. 2. It can increase the diuretic and intraocular pressure-lowering effects of diuretics and carbonic anhydrase inhibitors. The dose should be adjusted when combined with these drugs.

Keep away from light and store in a sealed container.

250ml:50g