Osmotic diuretic
Mannitol
Adult dose
Dose: Raised ICP: 0.25–1g/kg of 20% solution IV over 10–30 min, repeat every 4–6h. Cerebral oedema: 0.5–1g/kg
Route: IV
Frequency: PRN
Clinical pearls
- Raised ICP, cerebral oedema, prevention of acute kidney injury (limited evidence)
- Use in-line filter; check for crystals in cold solutions
Contraindications
- Anuria
- Severe heart failure
- Severe pulmonary oedema
- Active intracranial bleeding (after evacuation)
- Severe dehydration
Side effects
- Pulmonary oedema
- Hypotension
- Renal impairment (osmotic nephrosis with high doses)
- Electrolyte disturbance
- Hypovolaemia
Interactions
- Diuretics (additive)
- Other nephrotoxics
Monitoring
- BP
- Urine output
- U&E
- Serum osmolality (target 300–320)
Reference: BNF; NICE NG232 (head injury); https://bnf.nice.org.uk/drugs/mannitol/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines