Therapeutic use

Osmotic diuretics are used as prophylactic therapy when nephron toxicity is anticipated, for example when diagnostic studies or therapeutic intervention require intravenous contrast agents, and during vascular surgery or when increased intracranial pressure is diagnosed. The rationale for administering mannitol in the first clinical situation is to decrease the concentration capacity of the urine which inhibits the concentration of the contrast agent within the tubular lumen, thus preventing its toxicity. However, when the nephron becomes impermeable to mannitol, it becomes ineffective.

In vascular (aortic) surgery, the superior efficacy of mannitol over methods which maintain a hyperhydration state is controversial ( Puschettin1994). Furthermore, when aortic cross-clamping takes place above the renal arteries, no preventive effects have been documented.

In cases of increased intracranial pressure, migration of the fluid from the intracellular to the extracellular space allows shrinkage of the brain, which ultimately decreases the swelling of the brain and relieves intracranial hypertension. Intraocular pressure is reduced in a similar way.

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