Cardiovascular – Renal Drugs : Diuretics
IMANN4 “Mannitol injection” 200 mg/ml; 500 ml/bot
適應症：頭部手術時，腦容積之腫大；腦深部手術時，腦外傷及惡性腦腫傷、腦壓亢進、眼內壓亢進。
Usual dose:
Incranial pressure:
Adult: 0.25 g/kg IV q6-8h, max. 6 g/kg/24 h.
Pediatric: 0.25 g/kg IV push q5min as needed; may increase step-wise to 1 g/kg/dose, max. 2 g/kg/dose.
Intracranial pressure ( to reduce brain mass before/after neurosurgery):
Adult: 1.5-2 g/kg IV over 30-60 min.
Intraocular pressure:
Adult: 1.5-2 g/kg IV infused over 30-60 min as a 15-20% solution; max.6 g/kg/24 h.
Pediatric: 1-2 g/kg IV as a 15-20% solution infused over 30-60 min; max. 2 g/kg/dose.
Renal impairment/oliguria treatment:
Adult: use test dose; 300-400 mg/kg (21-28 g for a 70-kg p’t) or up to 100 g of solution, given as a single dose (often in addition to furosemide).
Renal impairment/oliguria prophylaxis: (during cardiac and other surgeries):
Adult: 50-100 g IV as a 5-15% solution (concentration dependent on p’t’s fluid requirements).
Toxicity/poisonings, nonspecific:
Adult: continuous IV infusion as a 5-20% solution (concentration dependent on p’t’s fluid requirements and urinary output); discontinue if no benefit is shown after infusion of 200 g.
Pediatric: up to 2 g/kg as a 5-10% solution.
Renal impairment:
Pediatric: 0.25-2 g/kg as a 15-20% solution over 2-6 h; max. 6 g/kg/24 h.
Edema:
Pediatric (neonates): 0.25-0.5 g/kg IV as a 15-20% solution over 30-60 min; repeat q8-12h as needed.
Dose adjustment:
Small, debilitated p’ts: doses of 500 mg/kg may be sufficient.
Contraindication:
Anuria, dehydration (severe), heart failure or pulmonary congestion (after initiation of mannitol), intracranial bleeding (except during craniotomy), pulmonary edema/congestion, renal damage/dysfunction (after initiation of mannitol).
Adverse effect:
Common: chest pain, hypotension, palpitations, tachyarrhythmia, disorder of fluid and/or electrolyte, hypernatremia, hyponatremia, hyperkalemia, diarrhea, nausea, vomiting, xerostomia, headache, rhinitis.
Serious: thrombophlebitis, acidosis, seizure, renal failure, urinary retention, pulmonary edema.