Adverse effect of mannitol

Mannitol IV

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 1/11/2019

Mannitol I.V. (mannitol injection) is a diuretic used to increase urine production, and to treat or prevent medical conditions that are caused by an increase in body fluids/water (e.g., cerebral edema, glaucoma, kidney failure). Mannitol I.V. is available in generic form. Common side effects of Mannitol I.V. include:

The usual adult dosage of Mannitol ranges from 50 to 200 g in a 24-hour period, but in most instances an adequate response will be achieved at a dosage of approximately 100 g/24 hours. Mannitol may interact with other drugs. Tell your doctor all medications and supplements you use. During pregnancy, Mannitol should be used only if prescribed. Consult your doctor before breastfeeding.

Our Mannitol I.V. (mannitol injection) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Mannitol Side Effects

Medically reviewed by Drugs.com. Last updated on Nov 1, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

For the Consumer

Applies to mannitol: parenteral powder for injection, urogenital irrigation solution for irrigation

Side effects include:

Fluid and electrolyte imbalance.

For Healthcare Professionals

Applies to mannitol: compounding powder, inhalation kit, intravenous solution, irrigation solution

Cardiovascular

Cardiovascular side effects have included hypotension and tachycardia. Venous thrombosis or phlebitis extending from the injection site and hypervolemia have occurred rarely and are generally associated with the solution or technique used in administration.

Respiratory

Respiratory side effects have included pulmonary congestion and rhinitis. Respiratory side effects associated with mannitol inhalation have included cough, gagging, wheeze, and decreased forced expiratory volume.

Metabolic

Metabolic side effects have included fluid and electrolyte imbalance, acidosis, and electrolyte loss.

Nervous system

Nervous system side effects have included headache, convulsions, and dizziness.

Hematologic

Hematologic side effects have included thrombophlebitis.

Other

Eight cases of mannitol IV overdose in patients with preexisting renal failure were reviewed. Symptoms presented in the reviewed cases were CNS involvement out of proportion to uremia, severe hyponatremia, large osmolality gap, and fluid overload. Six patients were treated with hemodialysis, one patient with peritoneal dialysis, and one patient died before initiation of treatment. All patients received large doses over 1 to 3 days with a mean dose of 310 +/- 182.8 g. CNS involvement consisted of CNS depression, confusion, lethargy, stupor, and coma. Two patients recovered cerebral function and continued on lifetime dialysis, 3 patients recovered renal and cerebral function, and 1 patient recovered renal function but had severe cerebral dysfunction.

Other side effects have included dryness of mouth, thirst, edema, arm pain, chills, dehydration, fever, mannitol intoxication, and angina-like pain.

Renal

Renal side effects have included acute renal failure.

Local

Local side effects have included extravasation. This effect is generally attributed to the solution or technique used in administration.

Dermatologic

Dermatologic side effects have included urticaria and skin necrosis.

Ocular

Ocular side effects have included blurred vision.

Immunologic

Immunologic side effects have included infection at the injection site and febrile response. These effects are usually attributed to solution or technique used in administration.

Gastrointestinal

Gastrointestinal side effects have included nausea and vomiting.

Genitourinary

Genitourinary side effects have included marked diuresis and urinary retention.

Psychiatric

Psychiatric side effects have rarely included mania (1 case report).

A 75-year-old woman with severe major depression experienced a manic episode 30 minutes after initiation of a 20% mannitol intravenous infusion for the treatment of acute angle closure glaucoma. The patient had been started on nortriptyline 50 mg per day for the treatment of depression ten days earlier. She received oral acetazolamide, topical pilocarpine, topical timolol, and topical dexamethasone concomitantly for the treatment of glaucoma. The mania resolved within approximately 1 hour following discontinuation of the mannitol infusion, and the patient returned to a severe depressive state. An extensive lab evaluation, toxicology screening, and medical examination failed to show additional secondary causes for mania in this patient.

1. “Product Information. Osmitrol (mannitol).” Baxter I.V. Systems Division, Round Lake, IL.

2. “Product Information. Aridol (mannitol).” Pharmaxis Inc, Exton, PA.

3. Better OS, Rubinstein I, Winaver JM, Knochel JP “Mannitol therapy revisited (1940-1997).” Kidney Int 52 (1997): 886-94

4. Sakemi T, Ikeda Y, Ohtsuka N, Ohtsuka Y, Tomiyoshi Y, Baba N “Acute renal failure associated with mannitol infusion and reversal with ultrafiltration and hemodialysis.” Nephron 73 (1996): 733-4

5. Doi K, Ogawa N, Suzuki E, Noiri E, Fujita T “Mannitol-induced acute renal failure.” Am J Med 115 (2003): 593-4

6. Edwards JJ, Samuels D, Fu ES “Forearm compartment syndrome from intravenous mannitol extravasation during general anesthesia.” Anesth Analg 96 (2003): 245-6, table of contents

7. Navarro V, Vieta E, Gasto C “Mannitol-induced acute manic state.” J Clin Psychiatry 62 (2001): 126

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

More about mannitol

  • During Pregnancy
  • Dosage Information
  • Drug Interactions
  • Pricing & Coupons
  • En EspaƱol
  • Drug class: miscellaneous diuretics
  • FDA Alerts (1)

Consumer resources

  • Mannitol
  • Mannitol (Systemic)
  • Mannitol Inhalation (Advanced Reading)

Other brands: Osmitrol, Aridol, Resectisol

Professional resources

  • Mannitol (AHFS Monograph)
  • … +3 more

Related treatment guides

  • Cerebral Edema
  • Diagnosis and Investigation
  • Oliguria

Bookshelf

Mechanism of Action

Mannitol is a six-carbon, linear, simple sugar which is only mildly metabolized by the body and primarily excreted rapidly by the kidneys when given intravenously and poorly absorbed when taken orally.

The FDA-approved indications for mannitol are all for intravenous mannitol and detailed below.

Mannitol for Increased Intracranial Pressure

Mannitol may be used for the reduction of intracranial pressure. In this indication, mannitol administration is intravenous. Mannitol then constitutes a new solute in the plasma, which increases the tonicity of the plasma. Since mannitol cannot cross the intact blood-brain barrier, the increased tonicity from the mannitol draws water out of the brain parenchyma and into the intravascular space. The water then travels with the mannitol to the kidneys where it gets excreted in the urine.

The mannitol causes the cells in the brain to dehydrate mildly. The water inside the brain cells (intracellular water) leaves the cells and enters the bloodstream as the mannitol draws it out of the cells and into the bloodstream. Once in the bloodstream, the extra water is whisked out of the skull. When the mannitol gets to the kidneys, the kidneys filter the mannitol into the urine. The mannitol again draws the water with it, and diuresis (increased urination) ensues.

Mannitol to Reduce Intraocular Pressure

Mannitol may be used to reduce intraocular pressure when given intravenously. The mannitol is a new solute in the intravascular space, which increases the tonicity of the blood plasma. The increased tonicity of the blood plasma draws water out of the vitreous humor of the eye and into the intravascular space. Once in the intravascular space, the mannitol and associate water are excreted by the kidney. The decreased water of the vitreous humor lowers the intraocular pressure.

The mannitol dehydrates the vitreous humor. The mannitol draws water out of the vitreous humor and into the blood vessels as it passes by. When the vitreous humor has less water, after being dehydrated by the mannitol, it has less mass and thus creates less pressure. The lower pressure is less likely to damage the retina. The mannitol remains in the blood vessels and is excreted, with its associated water, into the urine.

Mannitol to Promote Diuresis in Acute Renal Failure

Mannitol can be used in acute renal failure to help prevent or treat the oliguric phase. During the oliguric phase urine output decreases to less than 0.5 mg/kg/hour for children and less than 400 mL/day in adults. The fluid which does not get excreted remains in the body and cause fluid overload. Fluid overload causes issues such as decreased oxygenation and ventilation, electrolyte abnormalities, swelling, encephalopathy, and cardiac arrest. An individual with acute renal failure can sometimes be giving intravenous mannitol. Even during acute renal failure, much of mannitol excretion is by the kidneys. As the mannitol gets excreted, it draws water with it, which can increase the water excretion of the patient and help avoid or treat the fluid overload caused by oliguria in acute renal failure. However, Mannitol causes significant osmotic injury to tubules leading to ATN(acute tubular necrosis) so its use for this indication is almost obsolete.

Mannitol to Excrete Toxic Materials

Much like mannitol given for oliguria of acute renal failure, mannitol can be given to increase the excretion of toxic materials, substances, and drugs. The kidneys excrete mannitol. The mannitol is poorly reabsorbed once excreted and thus draws extra water with it into the renal collecting ducts. The extra water in the renal collecting ducts can help increase the excretion of water-soluble toxic materials, substances, and drugs.

Mannitol to Prevent Intradialytic Hypotension

Intradialytic hypotension and dialysis disequilibrium symptoms are common in hemodialysis patients. This is due to a drop in intradialytic osmolality. Mannitol can be used to prevent intradialytic hypotension by raising serum osmolality.

Additional Mechanisms of Action

Since mannitol is a sugar and it provides a sweet taste when ingested orally. Mannitol also mostly passes through the intestine and is excreted in the feces as the small intestine absorbs it poorly. Thus, mannitol is used as a sweetener in food for diabetic patients as mannitol can provide sweetness to the food without increasing the blood sugar as much as sucrose.

Mannitol injection

What is this medicine?

MANNITOL (MAN i tawl) is a diuretic. It is used to reduce pressure and swelling around the brain and in the eyes. It is also used to prevent or treat kidney failure. This medicine is also used during some urology procedures.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Osmitrol

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • bleeding in the brain, head injury or trauma

  • dehydration

  • fluid on the lungs

  • heart failure

  • kidney disease

  • small amount of urine output

  • an unusual or allergic reaction to mannitol, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

This medicine is for infusion into a vein or into the urethra. It is given by a health care professional in a hospital or clinic setting.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 12 years of age for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply.

What may interact with this medicine?

  • levomethadyl

  • lithium

  • other diuretics

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

You will be monitored closely while you are on this medicine.

You may need to be on a special diet while taking this medicine. Check with your doctor. Also, ask how many glasses of fluid you need to drink a day. You must not get dehydrated.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • breathing problems

  • changes in vision

  • chest pain

  • confusion

  • fast, irregular heartbeat

  • feeling faint or lightheaded, falls

  • fever or chills

  • increased thirst

  • irritation, pain at site where injected

  • muscle pain, weakness

  • seizures

  • swelling of the ankles, feet, hands

  • trouble passing urine or change in the amount of urine

  • unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • diarrhea

  • dry mouth

  • headache

  • nausea, vomiting

  • runny nose

  • skin sores

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *