Mannitol adverse effects

Toxicity. Sugar alcohols are classified as relatively harmless. Acute oral toxicity values in mice for mannitol and sorbitol (5) are given in Table 4. The acute oral LD q value for xyUtol in mice is 25.7 g/kg (205). Ingestion of 10 g/d of either mannitol or sorbitol by a normal human subject for one month resulted in no untoward effects (206). XyUtol given to healthy humans for 21 d in increasing doses up to 75 g/d produced no adverse effects (207). The limiting dose of xyUtol for production of diarrhea in humans is 20—30 g (4), but tolerance usually develops on continued adrninistration (207). 

Saline laxatives (magnesium citrate, magnesium sulfate, sodium sulfate, and disodium phosphate) or saccharide laxatives (sorbitol, mannitol, lactulose) are also used in poisoned patients. Common adverse effects are abdominal cramps, excessive diarrhea, and abdominal distension. Dehydration and electroljde imbalance in children, and hjrpermagnesemia and magnesium toxicity (with magnesium-based cathartics) have also been reported. 

Most investigators administer 0.45% saUne in combination with 5% dextrose intravenously in various amounts (around 1000-1500 ml starting 12 hours before administration of radiocontrast agents). There is no controlled study that assessed oral hydration in these patients. Until now, there has been no investigation as to how long hydration should be continued. From a theoretical point of view the use of hyperosmolar fluids (such as 15% mannitol) in addition to the administration of the hyperosmolar contrast media may have adverse effects. Therefore, it is not surprising that most studies failed to observe a benefi-... 

What adverse effects are common with mannitol therapy ... 

Osmotic diuretics induce few adverse effects, but expansion of the extracellular fluid volume can occur, as noted above. Alteration of blood sodium levels can be seen, and these drugs should not be used in anuric or unresponsive patients. If cranial bleeding is present, mannitol or urea should not be used. 

A. Parenteral. Dantrolene sodium (Dantrium), 20 mg of lyophilized powder for reconstitution (after reconstitution, protect from light and use within 6 hours to ensure maximal activity). Each 20-mg vial contains 3 g of mannitol (see adverse effects and interactions). 

Mannitol is stable in the dry state and in aqueous solutions. Solutions may be sterilized by filtration or by autoclaving and if necessary may be autoclaved repeatedly with no adverse physical or chemical effects. In solution, mannitol is not attacked by cold, dilute acids or alkalis, nor by atmospheric oxygen in the absence of catalysts. Mannitol does not undergo Maillard reactions. 

Mannitol is the most frequently prescribed osmotic diuretic. The side effects and adverse reactions include fluid and electrolyte imbalance, pulmonary edema from rapid shift of fluids, nausea, vomiting, tachycardia from rapid fluid loss, and acidosis. 

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