Pharmacology

1. 
   

   Mannitol is an osmotically active solute diuretic. Mannitol inhibits water reabsorption at the loop of Henle and the proximal tubule. The increase in urine output usually is accompanied by an increase in solute excretion. In addition, mannitol transiently increases serum osmolality and decreases CSF pressure by creating an osmotic gradient between brain tissue and the vascular compartment. Water moves across this gradient into the blood vessels, lowering the CSF pressure and decreasing intracranial pressure.

   
   
2. 
   

   Mannitol may reverse the effects of ciguatoxin by inhibiting ciguatoxin-induced opening of sodium channels and reducing cellular excitability. Mannitol may also increase the dissociation of ciguatoxin from its binding sites on cell membranes.

   
   
3. 
   

   In the past, mannitol was used to induce “forced diuresis” for some poisonings (eg, phenobarbital, salicylate) to enhance their renal elimination, but this use has been abandoned because of lack of efficacy and potential risks (cerebral and pulmonary edema).

Indications

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