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      Acute Renal Failure following Massive Mannitol Infusion

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          Abstract

          Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 ± 439 g (mean ± SD) during a time period of 58 ± 28 h. The infusion rate was 0.25 ± 0.02 g/kg/h. The onset of acute renal failure was detected 48 ± 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 ± 11 mEq/l), and hyperosmolality (osmolar gap 70 ± 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension – one of them while recovering – on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.

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          Most cited references 3

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          Acute renal failure following massive mannitol infusion. Appropriate response of tubuloglomerular feedback?

          Two patients suffered reversible acute oligoanuric renal failure following massive mannitol infusion (400 to 900 g/day) given as treatment for intracranial hypertension. We believe this to be a previously unreported complication. Both patients had normal renal function before therapy. Serum creatinine level rose to 7.4 mg/dL (654 mumole/L) in patient 1 and to 2.7 mg/dL (238 mumole/L) in patient 2. Measured and calculated serum osmolality were 362 and 301 mOsm/kg, respectively, in patient 1 and 333 and 220 mOsm/kg, respectively, in patient 2. Other causes of renal failure were excluded. We postulate that the mannitol-induced increase in solute delivery to the macula densa may have triggered an intense tubuloglomerular feedback response resulting in a marked fall in glomerular filtration rate. Alternatively, mannitol infusion may have caused tubular cell swelling with luminal obstruction.
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            Acute renal failure associated with mannitol intoxication. Report of a case

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              Mannitol intoxication in patients with renal failure

               H. Borges (1982)
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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2002
                December 2002
                07 October 2002
                : 22
                : 5-6
                : 573-575
                Affiliations
                Department of Nephrology, Hospital Xeral de Vigo, Servicio Galego de Saúde, Spain
                Article
                65279 Am J Nephrol 2002;22:573–575
                10.1159/000065279
                12381962
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 2, References: 10, Pages: 3
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/65279
                Categories
                Case Report

                Cardiovascular Medicine, Nephrology

                Mannitol, Hyperosmolality, Acute renal failure, Hyponatremia

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