Mannitol – Uses, Mechanism and Side Effects
Mannitol is a naturally occurring sugar alcohol used in medicine as an osmotic diuretic, to reduce intracranial pressure, and as a pharmaceutical excipient.
Wissenswertes über "Mannitol"
Mannitol is a naturally occurring sugar alcohol used in medicine as an osmotic diuretic, to reduce intracranial pressure, and as a pharmaceutical excipient.
What is Mannitol?
Mannitol is a six-carbon sugar alcohol (polyol) that occurs naturally in various plants, fungi, and algae. It is a structural isomer of sorbitol and is used both as an active pharmaceutical ingredient and as an excipient in drug formulations. In the food industry, it is used as a sweetener under the designation E421.
Mechanism of Action
Mannitol acts as an osmotic diuretic. When administered intravenously, it raises the osmolarity of the blood plasma, drawing fluid from tissues into the vascular compartment. In the kidneys, mannitol is freely filtered by the glomeruli but is not significantly reabsorbed in the tubules. This retains water within the tubular lumen and promotes urinary excretion. This osmotic effect is exploited clinically to reduce elevated pressure in closed body compartments such as the skull or the eye.
Medical Indications
- Cerebral edema and raised intracranial pressure: Mannitol is a first-line agent for acutely reducing intracranial pressure, for example following traumatic brain injury or in the setting of cerebral edema.
- Acute angle-closure glaucoma: Mannitol can rapidly lower elevated intraocular pressure during a glaucoma crisis.
- Acute kidney injury prevention: Used to promote diuresis and protect renal function in selected clinical scenarios.
- Poisoning and drug toxicity: To enhance renal elimination of certain toxins.
- Cystic fibrosis: Inhaled mannitol powder (Bronchitol) is used to improve mucociliary clearance in the airways.
Dosage and Administration
In emergency and critical care settings, mannitol is administered as an intravenous infusion, typically as a 15–20% solution. The dose is individualized based on body weight, clinical condition, and the underlying indication, commonly ranging from 0.25 to 2 g/kg body weight. Administration must always occur under medical supervision with close monitoring of renal function and serum electrolytes.
Side Effects
Mannitol may cause the following adverse effects:
- Electrolyte disturbances (e.g., hypokalemia, hypernatremia)
- Fluid overload or dehydration if dosing is not carefully controlled
- Renal impairment with high doses or prolonged use
- Headache, nausea, vomiting
- Volume-related cardiac stress or heart failure exacerbation
- Rarely: hypersensitivity reactions
Contraindications
Mannitol should not be used in patients with:
- Severe renal failure with anuria
- Severe heart failure
- Pulmonary edema
- Severe dehydration
- Known hypersensitivity to mannitol
Mannitol as a Food Additive
As a sugar substitute, mannitol is approved under the food additive code E421 and is found in chewing gum, confectionery, and diabetic food products. It provides approximately 60% of the sweetness of sucrose and has a very low glycemic index. Consumption of large amounts may have a laxative effect.
References
- European Medicines Agency (EMA): Bronchitol (Mannitol) - Summary of Product Characteristics. EMA, 2023.
- Bhardwaj A, Ulatowski JA. Cerebral edema: hypertonic saline solutions. Current Treatment Options in Neurology, 2004;6(3):201-210.
- Wakai A, McCabe A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database of Systematic Reviews, 2013;8:CD001049.
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Related search terms: Mannitol + Mannitolum + Mannite