Mannitol complications

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  1. Hyperosmolar agents such as mannitol inhibit CSF formation, open endothelial cells in the blood-brain barrier through dehydration, and increase intracranial compliance
    1. the initial decrease in ICP seen with mannitol administration is thought to result from an immediate lowering of blood viscosity, this hypoviscocity actually causes some cerebral vasoconstriction
    2. 1g/kg of mannitol decreases CSF production 52%; maximum reduction of ICP is reached in about 90 minutes and returns to baseline after about 4 hours
    3. mannitol also increases CPP
    4. mannitol may have a positive effect on cardiac output; increases CBF
  2. chronic and repeated administration of mannitol can cause a severe hyperosmolar state leading to kidney failure; hypokalemia and hypernatremia are common side effects that also can complicate chronic mannitol administration
    1. serum osmolality should be kept under 320 mosmol/kg
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