Q: If Mannitol is given to a patient with renal failure it may cause? (select one)
A) Hyponatremia and hyperkalemia
B) hypernatremia and hypokalemia
Answer: A
The objective of this question is to lead students to mechanism of mannitol and electrolyte behavior across the cell membrane. In patients with renal failure, mannitol is retained in the circulation, which leads to increased plasma osmolality. This mechanism is very much like hyperglycemia. This increased plasma osmolality, moves water and potassium out of cells, causing extracellular fluid volume expansion, pulmonary edema, (dilutional) hyponatremia, and hyperkalemia.
In patients, with normal kidneys, mannitol is usually tolerable as it does not get retained in the system.
#electrolytes
References:
1. Aviram A, Pfau A, Czaczkes JW, Ullmann TD. Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 1967; 42:648.
2. Fanous AA, Tick RC, Gu EY, Fenstermaker RA. Life-Threatening Mannitol-Induced Hyperkalemia in Neurosurgical Patients. World Neurosurg 2016; 91:672.e5.
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