A Drug Study on

Mannitol (Osmitrol)

In Partial Fulfillment of the

Requirements in NCM – 216 RLE

PERCEPTION & COORDINATION NURSING ROTATION

Submitted to:

Date:

April 28, 2022

 Generic Name Mannitol

Brand Name Osmitrol

Drug Classification Therapeutic Class: Diuretics

Pharmacologic Class: Osmotic diuretics

Pregnancy Category C

Mode of Action Increases osmotic pressure of plasma in glomerular filtrate,

inhibiting tubular reabsorption of water and electrolytes
(including sodium and potassium). These actions enhance
water flow from various tissues and ultimately decrease
intracranial and intraocular pressures; serum sodium level
rises while potassium and blood urea levels fall. Also protects
kidneys by preventing toxins from forming and blocking
tubules.

Dosage and Route ● Edema

➔ Adult: IV after test dose, use product 10%-20% at a
rate of 25-75 mL/hr; give loop diuretics before mannitol
➔ Child (unlabeled): IV 0.5-2 g/kg of 15%-20% mannitol
over 2-6 hr

● Intraocular pressure
➔ Adult: IV 1.5-2 g/kg of 15%-20% sol over 30-60 min

● ICP
➔ Adult: IV 1-2 g/kg, then 0.25-1 g/kg q4hr

● Diuresis with drug intoxication

➔ Adult/child >12 yr: 5%-25% sol continuously up to 200
g IV while maintaining 100-500 mL urine output/hr

● Kidney transplant
➔ Adult donor: IV 12.5 g before nephrectomy, with
adequate hydration, may repeat. Recipient: 50 g
 before revascularization

● Traumatic brain injury (unlabeled)

➔ Adult: IV 1.4 g/kg before neurosurgery with fluid
replacement
➔ Available forms: Inj 5%, 10%, 15%, 20%, 25%; GU
irrigation: 5%; inhalation capsule challenge kit

Indication ● Prevention and treatment of the oliguric phase of renal

failure
● Reduction of intracranial pressure and treatment of
cerebral edema; of elevated IOP when the pressure
cannot be lowered by other means
● Promotion of the urinary excretion of toxic substances
● Diagnostic use: Measurement of GFR

Contraindication ● Contraindicated in: Hypersensitivity; Anuria;

Dehydration; Active intracranial bleeding; Severe
pulmonary edema or congestion; Progressive
Heart/Renal Failure; Acute MI; Aneurysm; Stroke.
● Use Cautiously in: OB, Lactation:Safety not
established.

Side Effect ● Frequent:

➔ Dry mouth, thirst.

● Occasional:
➔ Blurred vision, increased urinary frequency/volume,
headache, arm pain, backache, nausea, vomiting,
urticaria, dizziness, hypotension, hypertension,
tachycardia, fever, angina-like chest pain.

Adverse Effect Fluid, electrolyte imbalance may occur due to rapid

administration of large doses or inadequate urine output
resulting in overexpansion of extracellular fluid. Circulatory
overload may produce pulmonary edema, HF. Excessive
diuresis may produce hypokalemia. Fluid loss in excess of
electrolyte excretion may produce hypernatremia,
hyperkalemia.

Drug Interaction ● DRUG:

➔ Digoxin: increased risk of digoxin toxicity
➔ Diuretics: increased therapeutic effects of mannitol
➔ Lithium: increased urinary excretion of lithium

● HERBAL:
➔ Yohimbe may decrease its effects.
 ● FOOD:
➔ None known.

● LAB VALUES:
➔ May decrease: serum phosphate, potassium.
➔ May increase: serum sodium, serum osmolality.

Nursing 1. Acquire patient’s complete medical history.

Responsibilities R: To watch out for contraindications and cautions or any
known allergies to this drug to avoid adverse reactions.

2. Perform a thorough physical assessment.

R: To establish baseline data before drug therapy begins, to
determine effectiveness of therapy, and to evaluate for
occurrence of any adverse effects associated with drug
therapy.

3. Do not expose solutions to low temperatures.

R: Crystallization may occur. If crystals are seen, warm the
bottle in a hot water bath, then cool to body temperature
before administering. Do not administer a solution in which
crystals remain undissolved. Use an in-line filter for 15%,
20%, and 25% infusions.

4. Do not administer electrolyte-free mannitol solution

with blood.
R: If blood must be administered simultaneously with
mannitol, add at least 20 mEq NaCl to each liter of mannitol.

5. Tell patient drug may cause thirst or dry mouth.

R: Emphasize that fluid restrictions are necessary, but that
frequent mouth care should ease these symptoms.

6. Administer drug with food or milk if GI is upset.

R: To buffer drug effect on the stomach lining.

7. Administer intravenous diuretics slowly.

R: To prevent severe changes in fluid and electrolytes.

8. Monitor patient response to drugs through vital signs,

weight, serum electrolytes and hydration
R: To evaluate effectiveness of drug therapy.

9. Monitor liver and renal function tests

R: To identify the need for possible dose adjustment and
 toxic effects.

10. Observe infusion site frequently for infiltration.

R: Extravasation may cause tissue irritation and necrosis.

References:

Hodgson, B. B., & Kizior, R. J. (2019). Saunders nursing drug handbook. Philadelphia:
Saunders.

RN Pedia. (n.d.). Diuretics Nursing Considerations & Management. Retrieved on April

20, 2022 from
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/diuretics/

Schull, P. (2020). McGraw-Hill Nurses Drug Handbook. Seventh Edition. New York, New
York: McGraw-Hill Education

Skidmore-Roth, L. (2019). Mosby’s 2019 Nursing Drug Reference. Thirty second

Edition. St.Louis, Missouri: Elsevier.

Vallerand, A.H, Sanoski,C., & Deglin, J.H. (2015). Davis’s Drug Guide for Nurses.
Fourteenth Edition. Philadelphia: F.A. Davis Company