Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol

Because of the life-threatening complications associated with the untimely and massive administration of mannitol, this substance should be given only when its diuretic effect can be watched carefully, and its administration should be discontinued if a small trial dose is not followed by an immediate diureic response.

Abstract

Three cases are described in which hypertonic mannitol solutions were given during the early phases of acute renal failure, leading to a severe clinical state of vascular overfilling together with plasma hyperosmolality and hyponatremia. Peritoneal dialysis in one case corrected the overhydration but failed to remove enough of the mannitol and caused an additional increase in plasma osmolality. In this case and in one other less severe case both hyperosmolality and hyponatremia were corrected by hemodialysis. Because of the life-threatening complications associated with the untimely and massive administration of mannitol, which has been described here, this substance should be given only when its diuretic effect can be watched carefully, and its administration should be discontinued if a small trial dose is not followed by an immediate diuretic response. Hyperosmolality caused by mannitol in anuric or oliguric patients can be treated successfully by hemodialysis.