[Harjodi]

Does anyone have a protocol for Mannitol in use?

[bellehill]

We don't have written protocol, but it is generally started at 25g IVPB Q6h with osmo draws before the dose. The mannitol dose will be held if osmo>315-320, depending on MD. Occassionally we will have someone getting mannitol q4h or a 50g dose PRN for elevated ICP. Was there something specific you were looking for?

[failou]

hello bellehil.
i have no protocol for manitol
but a few tips are available.i am sure you know all the benefits of manitol.
better focus on what not doing.
1.dont give it to pt with hypotension <90 mmhg..
2.dont give it to pt with osmo>315-320
3.dont give to a pt dehydrated with high serum na+
4.dont give ut to pt with hyponatremia.
5. dont give it to a pt with congestive heart failure(pulmonary edena)
6.dont give it slowly iv(20-30 min)
7.dont stop manitol at once(rebound).
8.be careful from a.t.n (nephrotoxicity)
9.to give manito to pt with contusions is controversial
these are not the ten commandnents but i hope it helps
let me know if you need more
by-by

[TNNURSE]

Mannitol - Hold for NA+ above 150
Hold for Osmo above 320.
Use good old fashioned common sense re: hypotension monitoring,and of course do serum sodium and osmo levels q 4hr initially x3 then q 6hr therafter, watch how quickly that serum na + is trending upward.Remember if you shoot that NA+ up too high too quickly...that in and of itself can cause cerebral injury/brain damage.You want to see it trend steadily upward...so watch the cvp and make sure the heart is taking this therapy without incident also/

[TNNURSE]

Originally Posted by failou

hello bellehil.
i have no protocol for manitol
but a few tips are available.i am sure you know all the benefits of manitol.
better focus on what not doing.
1.dont give it to pt with hypotension <90 mmhg..
2.dont give it to pt with osmo>315-320
3.dont give to a pt dehydrated with high serum na+
4.dont give ut to pt with hyponatremia.
5. dont give it to a pt with congestive heart failure(pulmonary edena)
6.dont give it slowly iv(20-30 min)
7.dont stop manitol at once(rebound).
8.be careful from a.t.n (nephrotoxicity)
9.to give manito to pt with contusions is controversial
these are not the ten commandnents but i hope it helps
let me know if you need more
by-by

I think on #4 you meant HYPER natremia......bc.....you are administering that Mannitol for what reason? To dry out that brain...you want them dry..you want that NA + level high....up to 150.You are trying to attain a lil room for that tissue to swell without compression of arterial supply .By drying out that brain by utilizing a cerebral "diuretic" like mannitol.....sometimes that is the"lil bit" of room they need to avoid the complications of high ICP/vascular compression.

[pfitz1079]

10) All these rules are up for grabs if impending herniation is going to kill the patient before the potential complications of rapid manitol administration.

[TNNURSE]

Originally Posted by pfitz1079

10) All these rules are up for grabs if impending herniation is going to kill the patient before the potential complications of rapid manitol administration.

sad....but true.But....by rapidly infusing Mannitol....you shoot that NA up so high so quickly....and it causes/can potentially cause irreversible brain damage.So..you have to use some ethics in there too. BC.....what happens if ya saved the patient from herniation but.......now they have the mental functioning of an ameoba.What good have ya really served? Even with Grade 5's you have to use the parameters pretty much.I have seen patients who had rapid mannitol infusions/hot salts.....not a pretty sight....Endocrinology didnt even want to be "involved" with the case after they saw how quickly they shot the patients Na + level up. It went from like 135 to 168 in 2 hours..............yeah..it took enough csf outta that crani to allow for expansion.....but.......the end result was a vegatative vent dependant 30 something y/o.So....I use the parameters established by our Neurosurgeons on rates/amts for boluses etc etc.Its just an ethics thing for me.
Kinda like c3 fractures you get in......till that c spine is surgically immobilized how aggressive are you really going to be with assessing central pain response.Your c3 fx patient may maex4 to sternal rubs... but now they are a quad for life & mad as hell.So....all joking aside....you have to use situation based ethical decision making including the Neurosurgeons final input.