Mannitol is an antihypertensive agent belonging to Osmosis Diuretics. Osmosis diuretics include antihypertensive mannitol. Osmotic diuretics like mannitol can help people with renal illness get rid of extra water and poisons from their bodies. Read more about Mannitol.
Drugs for Gout ( Acute and Chronic gout)ANUSHA SHAJI
The current presentation include the pharmacotherapy of drugs for acute and chronic gout. Details include definition, classification of drugs, mechanism, pharmacokinetics, adverse effects, uses and contraindications.
These slides present directly acting arteriolar dilators i.e.cardiovascular drugs, their mechanism of action, pharmacological effects, pharmacokinetics, uses and precautions.
MD Microbiology also known as Doctor of Medicine in Microbiology, its a course of postgraduate level done after MBBS. Basically, it is a study of diagnosis, prevention, and treatment of all infectious diseases and understanding of the pathogenesis and laboratory diagnosis of infectious and non-infectious diseases. Read more about MD Microbiology In India https://medicaldialogues.in/medical-courses/md-microbiology-in-india-check-out-admission-process-fees-medical-colleges-to-apply-eligibility-criteria-99008
एम्लोडीपिन कैल्शियम चैनल ब्लॉकर वर्ग से संबंधित एक उच्चरक्तचापरोधी एजेंट है। एम्लोडीपिन एक कैल्शियम चैनल अवरोधक है जिसका उपयोग उच्च रक्तचाप और एनजाइना के इलाज के लिए किया जाता है। अधिक पढ़ें Amlodipine in hindi- एम्लोडीपिन के बारे में https://medicaldialogues.in/hi/generics/amlodipine-2721953
Drugs for Gout ( Acute and Chronic gout)ANUSHA SHAJI
The current presentation include the pharmacotherapy of drugs for acute and chronic gout. Details include definition, classification of drugs, mechanism, pharmacokinetics, adverse effects, uses and contraindications.
These slides present directly acting arteriolar dilators i.e.cardiovascular drugs, their mechanism of action, pharmacological effects, pharmacokinetics, uses and precautions.
MD Microbiology also known as Doctor of Medicine in Microbiology, its a course of postgraduate level done after MBBS. Basically, it is a study of diagnosis, prevention, and treatment of all infectious diseases and understanding of the pathogenesis and laboratory diagnosis of infectious and non-infectious diseases. Read more about MD Microbiology In India https://medicaldialogues.in/medical-courses/md-microbiology-in-india-check-out-admission-process-fees-medical-colleges-to-apply-eligibility-criteria-99008
एम्लोडीपिन कैल्शियम चैनल ब्लॉकर वर्ग से संबंधित एक उच्चरक्तचापरोधी एजेंट है। एम्लोडीपिन एक कैल्शियम चैनल अवरोधक है जिसका उपयोग उच्च रक्तचाप और एनजाइना के इलाज के लिए किया जाता है। अधिक पढ़ें Amlodipine in hindi- एम्लोडीपिन के बारे में https://medicaldialogues.in/hi/generics/amlodipine-2721953
Ranitidine is a gastro-intestinal agent that inhibits histamine H2 receptors.
The histamine H2 receptor antagonist ranitidine is used to treat erosive esophagitis, Zollinger-Ellison syndrome, gastric ulcers, GERD, and duodenal ulcers.
Prednisone is a member of the corticosteroid drug class. The effects of prednisone are thought to be anti-inflammatory, anti-neoplastic, and vasoconstrictive.
Prednisone has been approved for treating and managing episodes of blood issues, arthritis, cancer, immune system issues, eye diseases, respiratory issues, allergies, etc. as well as reducing their symptoms.
Azilsartan is an angiotensin II receptor blocker and hypertension medication. Azilsartan has been given the go-ahead to treat hypertension. Moreover, it prevents heart attacks and strokes and is used for heart failure.
Digoxin is an inotropic and antiarrhythmic drug that belongs to the class of cardiac glycosides.
Atrial fibrillation, atrial flutter, and heart failure can all be treated with digoxin. Moreover, it is utilised to treat foetal supraventricular tachyarrhythmia and supraventricular tachycardia.
Metronidazole is a member of the Nitroimidazole class of antibiotic, antimicrobial, and antiprotozoal medicines. The nitroimidazole drug metronidazole is used to treat bacterial infections, rosacea inflammation, amebiasis, trichomoniasis, and to prevent postoperative infections.
Lobun forte is a probiotic used for the reduction of uremic toxins in CKD patients. It is a combination of four probiotics, including Lactobacillus acidophilus, Bifidobacterium longum, Bacillus coagulans, and Streptococcus thermophilous. Read more about Lobun Forte https://medicaldialogues.in/partner/jbcpl/lobun-forte
Azmarda is usesful for the heart patient. Heart failure is a progressive chronic syndrome characterized by decrease in functional status and quality of life.
Metoprolol succinate, a medicine used to treat hypertension, belongs to the beta-blocker pharmacological class.
Metoprolol, an antihypertensive medication, competes with other medications to block beta-1 receptors at oral doses of less than 100 mg in adults, while having little to no effect on beta-2 receptors. Metoprolol reduces the quantity of oxygen needed by the heart at any given level of exertion, which aids in the treatment of heart failure. The long-term management of angina pectoris is aided as a result.
Vitamin D status is categorized based on serum 25 (OH) D levels, and the half-life of the vitamin is approximately 2 - 4 weeks. However, this half-life may be decreased even less than a week in the event of hemodilution, infection, or other catabolic diseases.D Rise is indicated for the treatment of Vitamin D3 (Cholecalciferol) deficiency. Read more about D rise.
Vitamin D status is categorized based on serum 25 (OH) D levels, and the half-life of the vitamin is approximately 2 - 4 weeks. However, this half-life may be decreased even less than a week in the event of hemodilution, infection, or other catabolic diseases.D Rise is indicated for the treatment of Vitamin D3 (Cholecalciferol) deficiency. Read more about D rise.
Mannitol is an Osmotic diuretic used to remove excess water and toxins from the body in patients with kidney disease. It is also used in the treatment of cerebral edema and intraocular pressure. It common side effects Headache, nausea, diarrhea, vomiting, dry mouth, thirst, dehydration, blurred vision, runny nose, arm pain, chills, dizziness, low blood pressure (hypotension), hives, irregular heartbeat, and electrolyte imbalance, etc. Read more about mannitol
D Rise contains Cholecalciferol, a fat-soluble vitamin that helps regulate serum calcium and phosphorous concentrations by enhancing the efficiency of the small intestine in absorbing these minerals from the diet. Read more about D-rise (https://d-rise.in/)
Amlodipine is a calcium channel blocker used to treat high blood pressure (hypertension). If you have high blood pressure, taking amlodipine can help to prevent future heart disease, heart attacks, and strokes.
MD Hospital Administration or Doctor of Hospital Administration is a Postgraduate level course for doctors in India that is done by them after completion of their MBBS. The duration of this postgraduate course is 3 years, and it focuses on the study of various concepts related to the field of overseeing the organizational side of health services.
Azmarda has sacubitril and valsartan which is the first approved agent in a new class of drug called angiotensin receptor neprilysin inhibitor (ARNI)3. Azmarda containing Sacubitril/ Valsartan is indicated in adults with long-term heart failure who have symptoms of the disease to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.Azmarda containing Sacubitril/ Valsartan exhibits the novel mechanism of action of an angiotensin receptor neprilysin inhibitor (ARNI) by simultaneously inhibiting neprilysin (neutral endopeptidase; NEP) via sacubitril, the active metabolite of the prodrug sacubitril, and by blocking the angiotensin II type-1 (AT1) receptor via valsartan. The complementary cardiovascular benefits and renal effects of Azmarda in heart failure patients are attributed to the enhancement of peptides that are degraded by neprilysin, such as natriuretic peptides (NP), by sacubitril and the simultaneous inhibition of the deleterious effects of angiotensin II by valsartan.
Sustained activation of the renin-angiotensin-aldosterone system results in vasoconstriction, renal sodium and fluid retention, activation of cellular growth and proliferation, and subsequent maladaptive cardiovascular remodeling. Valsartan inhibits detrimental cardiovascular and renal effects of angiotensin II by selectively blocking the AT1 receptor and also inhibits angiotensin II-dependent aldosterone release Read more about Azmarda https://medicaldialogues.in/partner/jbcpl/azmarda-sacubitril-valsartan
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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1. 1/5
September 21, 2022
Mannitol
medicaldialogues.in/generics/mannitol-2721823
Indications, Uses, Dosage, Drugs Interactions, Side effects
Mannitol
Medicine Type :
Allopathy
Prescription Type:
Prescription Required
Approval :
DCGI (Drugs Controller General of India)
Schedule
Schedule H
Pharmacological Class:
Osmotic Diuretics,
Therapy Class:
Antihypertensive,
Innovator name:
Baxter Healthcare Corporation
Mannitol is an antihypertensive agent belonging to Osmosis Diuretics.
Mannitol is an Osmotic diuretic used to remove excess water and toxins from the body in patients with kidney disease. It is also used in
the treatment of cerebral edema and intraocular pressure.
Approximately 7% of ingested mannitol is absorbed during gastrointestinal perfusion in uremic patients. Mannitol administered
intravenously has a volume of distribution of 34.3 L.Mannitol is metabolized only slightly, if at all, to glycogen in the liver.
Mannitol is primarily excreted unchanged in the urine. Intravenous administration of mannitol yields a total clearance of 5.1 L/hr and
renal clearance of 4.4 L/hr.
Mannitol shows common side effects Headache, nausea, diarrhea, vomiting, dry mouth, thirst, dehydration, blurred vision, runny nose,
arm pain, chills, dizziness, low blood pressure (hypotension), hives, irregular heartbeat, and electrolyte imbalance, etc.
Mannitol is available in the form of an Injectable solution
Mannitol is available in India, US, Japan, England, China, Austria, Canada, Europe and Italy.
Mannitol belonging to the Osmotic Diuretics acts as an antihypertensive agent.
Produces osmotic diuresis by increasing the osmotic pressure of glomerular filtrate, which inhibits tubular reabsorption of water and
electrolytes and increases urinary output. The mechanism of action in the reduction of Intracranial pressure (ICP) is less clear. However,
it is thought that mannitol reduces ICP by reducing blood viscosity which transiently increases cerebral blood flow and oxygen transport
and constricts pial arterioles. This in turn reduces cerebral blood volume and ICP. Furthermore, mannitol reduces ICP by withdrawing
water from the brain parenchyma and excreting water in the urine.
The onset of action of Mannitol is for Diuresis: 1 to 3 hours; Reduction in intracranial pressure: ~15 to 30 minutes.
2. 2/5
The Duration of Action for Mannitol in the body for Reduction in intracranial pressure: 1.5 to 6 hours.
The Tmax was not clinically established.
Mannitol is available in the form of an Injectable solution.
Mannitol Injectable solutions by Intravenous as single or several doses.
Mannitol is a diuretic used to force urine production in people with acute (sudden) kidney failure. Mannitol injection is also used to
reduce swelling and pressure inside the eye or around the brain.
Mannitol is an antihypertensive agent belonging to Osmosis Diuretics. Mannitol is an osmotic diuretic used to remove excess water and
toxins from the body in patients with kidney disease. It is also used in the treatment of cerebral edema and intraocular pressure. Frequent
monitoring of electrolytes levels is necessary during treatment with this medicine.
Mannitol is approved for use in the following clinical indications
The reduction of intracranial pressure and treatment of cerebral edema by reducing brain mass.
The reduction of elevated intraocular pressure when the pressure cannot be lowered by other means.
Promoting the urinary excretion of toxic substances.
Intracranial pressure, cerebral edema, reduction (off-label dosing):
IV: 0.25 to 1 g/kg/dose; may repeat every 6 to 8 hours as needed. Some suggest maintaining serum osmolality <320 mOsm/kg.
However, this value is routinely exceeded without ill effect. A better marker for mannitol toxicity may be the serum osmol gap (or osmolal
gap) and the target is <18 to 20.
Intraocular pressure, reduction:
Presurgical dosing: IV: 1.5 to 2 g/kg administered over 30 to 60 minutes 1 to 1.5 hours prior to surgery.
Traumatic hyphema: IV: 1.5 g/kg administered over 45 minutes twice daily for Intraocular pressure >35 mm Hg; may administer every 8
hours in patients with extremely high pressure.
Kidney transplant, intraoperative volume optimization (off label): Note: Concentrated mannitol (ie, 20%) is preferred to
optimize intravascular volume status.
IV: 12.5 to 25 g at kidney revascularization doses up to 50 g have been studied. Some experts utilize 1 g/kg (maximum dose: 75 g);
however, many centers utilize fixed dosing.
Mannitol is available in various strength as 5%, 10%, 15%, 20% and 25%.
Mannitol is available in the form of an Injectable solution.
Mannitol is contraindicated in patients with:
Well-established anuria due to severe renal disease.
Severe pulmonary congestion or frank pulmonary edema.
Active intracranial bleeding except during craniotomy.
Severe dehydration.
Progressive heart failure or pulmonary congestion after institution of mannitol therapy.
Do not administer to patients with a known hypersensitivity to mannitol.
● Extravasation: Vesicant (at concentrations >5%); ensure proper catheter or needle position prior to and during IV infusion. Avoid
extravasation of IV infusions; may cause compartment syndrome. Administration into a large central vein is recommended.
● Fluid/electrolyte imbalance: May cause hypervolemia and electrolyte disturbances; monitor for new onset or worsening cardiac or
pulmonary congestion. Also may cause profound diuresis with fluid and electrolyte loss; close medical supervision and dose evaluation are
required. Correct electrolyte disturbances; adjust the dose to avoid dehydration.
● Hypersensitivity: Serious hypersensitivity reactions (eg, anaphylaxis), including fatalities, have been reported. Discontinue mannitol
immediately if a hypersensitivity reaction develops and treat accordingly.
● Nephrotoxicity: May cause renal dysfunction, especially with high doses; use caution in patients taking other nephrotoxic agents, with
sepsis or preexisting renal disease. To minimize adverse renal effects, adjust to keep serum osmolality <320 mOsm/L. Discontinue if
evidence of acute tubular necrosis.
● Cerebral edema: In patients being treated for cerebral edema, mannitol may accumulate in the brain (causing rebound increases in
intracranial pressure) if circulating for long periods of time as with continuous infusion; intermittent boluses are preferred.
Cardiovascular status should also be evaluated; do not administer electrolyte-free mannitol solutions with blood. If hypotension occurs,
monitor cerebral perfusion pressure; reassess dose and use of mannitol if cerebral perfusion pressure decreased.
3. 3/5
● CNS effects: CNS toxicity (eg, coma, confusion, lethargy) may occur; the risk may be increased in patients with impaired renal
function or with concomitant use of neurotoxic drugs. Discontinue mannitol if CNS toxicity develops.
● Renal impairment: Use with caution. In patients with severe impairment, do not use until adequacy of renal function and urine flow
is established; use 1 to 2 test doses to assess renal response.
Breast Feeding Warning
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be
exercised when mannitol is administered to a nursing woman
Pregnancy Warning
Pregnancy category C
Animal reproduction studies have not been conducted with mannitol injection. It is also not known whether mannitol injection can cause
fetal harm when given to a pregnant woman or can affect reproduction. Mannitol injection should be given to a pregnant woman only if
clearly needed.
Common Adverse effects
Cardiac failure, chest pain, edema, hypertension, localized phlebitis, palpitations, peripheral edema, tachycardia, thrombophlebitis,
Chills, coma, confusion, dizziness, headache, increased intracranial pressure (rebound), lethargy, malaise, pain, seizure,
Diaphoresis, localized erythema, localized rash, pruritus, skin necrosis, skin rash, urticaria, Dehydration, fluid and electrolyte
disturbance, hyperkalemia, hypernatremia, hypervolemia, hypokalemia, hyponatremia, hypovolemia, increased thirst, metabolic
acidosis, metabolic alkalosis, Nausea, vomiting, xerostomia, Anuria, azotemia, diuresis, hematuria, oliguria, osmotic nephrosis,
urinary retention, Hemoconcentration, Local inflammation, local pain, local pruritus, Arm and/or wrist pain, asthenia, muscle
rigidity, myalgia, Blurred vision, Polyuria, Cough, pulmonary congestion, pulmonary edema, rhinitis, Fever.
Rare Adverse effects
Acute renal failure, anaphylaxis, central nervous system toxicity, dyspnea, hypersensitivity reaction, hypotension.
Amikacin Liposome
May enhance the nephrotoxic effect of Mannitol (Systemic).
● Aminoglycosides
Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
● Arsenic Trioxide
Osmotic Diuretics may enhance the QTc-prolonging effect of Arsenic Trioxide. Management: When possible, avoid concurrent use of
arsenic trioxide with drugs that can cause electrolyte abnormalities, such as osmotic diuretics.
● Desmopressin
Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin.
● Diacerein
May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased.
● Opioid Agonists
May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics.
● Sodium Phosphates
Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be
enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives
to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal
status.
● Tobramycin
Mannitol may enhance the nephrotoxic effect of Tobramycin (Oral Inhalation).
The common side effects of Mannitol include the following
Common
Headache, nausea, diarrhea, vomiting, dry mouth, thirst, dehydration, blurred vision, runny nose, arm pain, chills, dizziness, low
blood pressure (hypotension), hives, irregular heartbeat, and electrolyte imbalance.
4. 4/5
Rare
Fever, infection at the injection site, blot clot in a deep vein, thrombosis, leakage of intravenously infused medication, and fluid
overload in the blood (hypervolemia).
Pregnancy
Pregnancy Category C
Animal reproduction studies have not been conducted with Mannitol Injection. It is also not known whether mannitol can cause fetal
harm when given to a pregnant woman or can affect reproduction. Mannitol Injection should be given to a pregnant woman only if clearly
needed.
Nursing mothers
It is not known whether Mannitol is excreted in human milk. Because many drugs are excreted in human milk, caution should be
exercised when mannitol is administered to a nursing woman.
Pediatric use
Safety and effectiveness in children below the age of 12 have not been established.
Dosage requirements for patients 12 years of age and under have not been established.
Geriatric use
Clinical studies of Mannitol Injection did not include sufficient numbers of subjects aged 65 and over to determine whether they respond
differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and
younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range,
reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. This
drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with
impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection,
and it may be useful to monitor renal function.
Too rapid infusion of large amounts of mannitol will cause a shift of intracellular water into the extracellular compartment resulting
in cellular dehydration and overexpansion of the intravascular space with hyponatremia, congestive heart failure, and pulmonary
edema.
Repeated doses should not be given to patients with persistent oliguria as this can produce a hyperosmolar state and precipitate
congestive heart failure and pulmonary edema due to volume overload. Dosage must be carefully monitored and adjusted in
accordance with the clinical situation to avoid the consequences of overdosage.
Pharmacodynamic
Chemically, mannitol is an alcohol and a sugar, or a polyol; it is similar to xylitol or sorbitol. However, mannitol has a tendency to lose a
hydrogen ion in aqueous solutions, which causes the solution to become acidic. For this reason, it is not uncommon to add a substance to
adjust its pH, such as sodium bicarbonate. Mannitol is commonly used to increase urine production (diuretic). It is also used to treat or
prevent medical conditions that are caused by an increase in body fluids/water (e.g., cerebral edema, glaucoma, kidney failure). Mannitol
is frequently given along with other diuretics (e.g., furosemide, chlorothiazide) and/or IV fluid replacement. Inhaled mannitol has the
possibility to cause bronchospasm and hemoptysis; the occurrence of either should lead to discontinuation of inhaled mannitol.
Pharmacokinetics
Absorption
Approximately 7% of ingested mannitol is absorbed during gastrointestinal perfusion in uremic patients. Inhalation of 635 mg of mannitol
powder yields a plasma C of 13.71 μg/mL in 1.5 hours (T ) and a mean systemic AUC of 73.15 μg*h/mL.
Distribution
Mannitol administered intravenously has a volume of distribution of 34.3 L.
Metabolism and Excretion
Mannitol is metabolized only slightly, if at all, to glycogen in the liver.
Mannitol is primarily excreted unchanged in the urine. Following oral inhalation of 635 mg of mannitol in healthy volunteers, 55% of the
total dose was recovered unchanged in the urine; following oral or intravenous administration of 500 mg, the corresponding values were
54 and 87%, respectively. Mannitol has an elimination half-life of 4.7 hours following oral administration; the mean terminal elimination
half-life is similar regardless of administration route (oral, inhalation, and intravenous. Intravenous administration of mannitol yields a
total clearance of 5.1 L/hr and renal clearance of 4.4 L/hr.
There are some clinical studies of the drug Mannitol mentioned below:
max max
5. 5/5
1. Shawkat H, Westwood MM, Mortimer A. Mannitol: a review of its clinical uses. Continuing education in anaesthesia, critical care
and pain. 2012 Apr 1;12(2):82-5.
2. Yang B, Xu J, Xu F, Zou Z, Ye C, Mei C, Mao Z. Intravascular administration of mannitol for acute kidney injury prevention: a
systematic review and meta-analysis. PloS one. 2014 Jan 14;9(1):e85029.
3. WEISS DI, SHAFFER RN, WISE BL. Mannitol infusion to reduce intraocular pressure. Archives of Ophthalmology. 1962 Sep
1;68(3):341-7.
https://www.uptodate.com/contents/mannitol-systemic-drug-information?
search=mannitol&source=panel_search_result&selectedTitle=1~145&usage_type=panel&showDrugLabel=true&display_rank=1#F286
https://www.rxlist.com/consumer_mannitol_osmitrol/drugs-condition.htm
https://reference.medscape.com/drug/osmitrol-mannitol-343061#0
https://www.syrianclinic.com/med/en/ProfDrugs/Mannitolpd.html#forms-cost
https://go.drugbank.com/drugs/DB00742
https://www.drugs.com/dosage/mannitol.html
https://www.practo.com/medicine-info/mannitol-174-api
Jyoti Suthar
Jyoti is a Post graduate in Pharmaceutics ( M Pharm) She did her graduation ( B Pharm) From SSR COLLEGE OF
PHARMACY And thereafter did her M Pharm specialized in Pharmaceutics from SSR COLLEGE OF PHARMACY
Dr JUHI SINGLA
Dr JUHI SINGLA has completed her MBBS from Era’s Lucknow Medical college and done MD pharmacology from SGT
UNIVERSITY Gurgaon. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751