Mannitol-induced acute renal failure

• Published in: Netherlands journal of medicine Vol. 50; no. 1; p. 21
• Main Authors: van Hengel, P, Nikken, J J, de Jong, G M, Hesp, W L, van Bommel, E F
• Format: Journal Article
• Language: English
• Published: Netherlands 01-01-1997
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - therapy; Aged; Diuretics, Osmotic - administration & dosage; Diuretics, Osmotic - adverse effects; Female; Humans; Infusions, Intravenous; Mannitol - administration & dosage; Mannitol - adverse effects; Reflex Sympathetic Dystrophy - complications; Reflex Sympathetic Dystrophy - drug therapy; Renal Dialysis
• ISSN: 0300-2977
• DOI: 10.1016/S0300-2977(96)00060-5

Mannitol is widely used because of its osmotic diuretic action and its presumed antioxidant properties. In pre-existent renal dysfunction, however, mannitol may accumulate leading to potentially deleterious effects. We describe a 71-year-old woman with moderate chronic renal failure due to diabetic nephropathy who developed acute anuric renal failure after mannitol administration for post-traumatic reflex sympathetic dystrophy. After haemodialysis symptoms of acute renal failure rapidly disappeared with recovery of pre-existent renal function. Daily measurement of the osmolal gap as a simple and accurate way of monitoring patients receiving mannitol infusion is emphasized. A rapid increase in the osmolar gap should prompt adjustment of the dose or even discontinuation of mannitol, especially in the case of pre-existent risk factors.