Mannitol: IV bolus or as side drip?

[tatara]

Some doctors order Mannitol as side drip, many as IV bolus. From my understanding Mannitol should be given rapidly as in IV bolus to achieve diffusion and reduce swelling through diuresis. I'm not confident with what I know and I'm confused. When I saw an opportunity, before I carried out the order, I asked the doctor why Mannitol has to be administered slowly (100ml to be infused for 30 minutes q 6hrs) for a VA trauma, GCS6 patient (BP ranging from 110/70 to 130/90, adequate hourly urine output), he just said plainly that it has to be that way as ordered, then he left.

I have faith in all you nurses in this site. I know you know better and are very helpful.

Thanks.

:redbeathe tatara

[GilaRRT]

Giving mannitol over 30 minutes is a reasonable way to administer. Significant shifts in fluids and electrolytes can occur with mannitol, a true "bolus" could be potentially disasterous.

[tatara]

Giving mannitol over 30 minutes is a reasonable way to administer. Significant shifts in fluids and electrolytes can occur with mannitol, a true "bolus" could be potentially disasterous.

Most of the time it is being administered as IV bolus, as ordered.

There were even some occasions that IV cath was ordered to be replaced with gauge18 just so mannitol can be administered that way.

I'd better probe deeper into this when I get to work later.

thanks!

Honestly, the side drip offers more convenience for me to complete the task. It's so hard to do an IV push of 100ml!

[GilaRRT]

Hospira states 30-60 minutes for the management of ICP. Giving a rapid bolus is potentially risky.

[wtbcrna, MSN, DNP, CRNA]

"Mannitol administered rapidly, can also cause peripheral vasodilation (hypotension) and short-term intravascular volume expansion, which would result in increased Intracranial pressure." Basics of Anesthesia 5th Ed. pg 459 All the references I have seen recommend not giving mannitol faster than 20-30min.

[flightnurse2b, LPN]

it's pretty standard where i work for mannitol to be administered as a drip, 100ml over one hour.

[wtbcrna, MSN, DNP, CRNA]

it's pretty standard where i work for mannitol to be administered as a drip, 100ml over one hour.

Dosage and rate depends on what it is being prescribed for: http://www.rxlist.com/mannitol-iv-drug.htm

Prevention of Acute Renal Failure (Oliguria): When used during cardiovascular or other types of surgery, 50 to 100 g of mannitol as a 5%, 10%, or 15% solution may be given. The concentration will depend on the fluid requirements of the patient.

Treatment of Oliguria: The usual dose to promote diuresis in oliguric patients: Adults, 300 to 400 mg/kg of body weight (21 to 28 g for a 70 kg patient) or up to 100 g of solution, given as a single dose (often in conjunction with furosemide); pediatric patients, 0.25 to 2 g/kg body weight or 60 g/m body surface area as a 15% to 20% solution over a period of 2 to 6 hours. Doses should not be repeated in patients with persistent oliguria.

Reduction of Intracranial Pressure and Brain Mass: In adults a dose of 0.25 to 2 g/kg body weight as a 15% to 25% solution administered over a period of 30 to 60 minutes; pediatric patients 1 to 2 g/kg body weight or 30 to 60 g/m² body surface area over a period of 30 to 60 minutes. In small or debilitated patients, a dose of 500 mg/kg may be sufficient. Careful evaluation must be made of the circulatory and renal reserve prior to and during administration of mannitol at the higher doses and rapid infusion rates. Careful attention must be paid to fluid and electrolyte balance, body weight, and total input and output before and after infusion of mannitol. Evidence of reduced cerebral spinal fluid pressure must be observed within 15 minutes after starting infusion.

Reduction of Intraocular Pressure: In adults a dose of 0.25 to 2 g/kg body weight as a 15% to 25% solution administered over a period of 30 to 60 minutes; pediatric patients 1 to 2 g/kg body weight or 30 to 60 g/m² body surface area over a period of 30 to 60 minutes. In small or debilitated patients, a dose of 500 mg/kg may be sufficient. When used preoperatively, the dose should be given one to one and one-half hours before surgery to achieve maximal reduction of intraocular pressure before operation.

Adjunctive Therapy for Intoxications: As an agent to promote urinary excretion of toxic substances: Adults may receive a 5% to 25% solution for as long as indicated if urinary output remains high; pediatric patients may receive 2 g/kg of body weight of a 5% or 10% solution. The concentration will depend upon the fluid requirement and urinary output of the patient. If benefits are not observed after 200 g of mannitol are administered, discontinue the mannitol therapy. Intravenous water and electrolytes must be given to match the loss of these substances in the urine, sweat and expired air.

Measurement of Glomerular Filtration Rate (GFR): 100 mL of a 20% solution (20 g) should be diluted with 180 mL of sodium chloride injection (normal saline) or 200 mL of a 10% solution (20 g) should be diluted with 80 mL of sodium chloride injection (normal saline). The resulting 280 mL of 7.2% solution is infused at a rate of 20 mL per minute. The urine is collected by catheter for a specific period of time and analyzed for mannitol excreted in mg per minute. A blood sample is drawn at the start and at the end of the time period and the concentration of mannitol determined in mg/mL of plasma. GFR is the number of mL of plasma that must have been filtered to account for the amount excreted per minute in the urine. Normal clearance rates are approximately 125 mL/minute for men; 116 mL/minute for women.

[Rinkishikika, BSN, RN]

no it has to be bolus or fast drip. slow infusion is risker