Mannitol induced AKI

Q: Mannitol-induced acute kidney injury tends to be?

A) reversible

B) irreversible

Answer: A

Care should be taken when writing repeated doses of mannitol. In a normal healthy patients AKI does not develop up to 200-300 grams of mannitol per day. This ballpark dose depends largely on underlying comorbidities and baseline kidney function, including diabetes, CHF, high APACHE or NIHSS score, other diuretic use and total cumulative dose of mannitol. 

Clinically, 6-11 percent of patients treated with mannitol are said to develop AKI. Although the mannitol induced AKI is slow to recover, the early institution of hemodialysis (HD) reverses the course quickly by removing cumulated mannitol within one or two sessions.

#pharmacology

#toxicology

References:

1. Gadallah MF, Lynn M, Work J. Case report: mannitol nephrotoxicity syndrome: role of hemodialysis and postulate of mechanisms. Am J Med Sci 1995; 309:219.

2. Pérez-Pérez AJ, Pazos B, Sobrado J, et al. Acute renal failure following massive mannitol infusion. Am J Nephrol 2002; 22:573.

Better OS, Rubinstein I, Winaver JM, Knochel JP. Mannitol therapy revisited (1940-1997). Kidney Int 1997; 52:886.

3. Lin SY, Tang SC, Tsai LK, et al. Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke: A Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e2032.

4. Kim MY, Park JH, Kang NR, et al. Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage. J Neurosurg 2014; 120:1340.