mannitol nephrotoxicity syndrome

Q: Acute Kidney Injury (AKI) developed due to mannitol therapy can be quickly reversed by hemodialysis (HD).

A) True

B) False

Answer: A (True)

If mannitol is used at a high dose, leading to an osmolal gap greater than 55 mosmol/kg, it may cause AKI by vasoconstriction. This phenomenon is known as mannitol nephrotoxicity syndrome.

AKI can be avoided by keeping the mannitol dose at the recommended lower level, i.e., 0.25 g/kg every four hours or 1.5 g/kg daily. Fortunately, this AKI is reversible either by stopping the mannitol or with a single or two sessions of HD. Without HD, it may take up to a week or so to get rid of excess mannitol. HD expedites the removal of excess mannitol.

#nephrology

#pharmacology

#toxicity

References:

1. Dorman HR, Sondheimer JH, Cadnapaphornchai P. Mannitol-induced acute renal failure. Medicine (Baltimore) 1990; 69:153.

2. 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.

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