I was recently asked to give 500mls of 20% mannitol as part of an institutional protocol to lower IOP before insertion of a Molteno drain for glaucoma. I felt this to be a substantial dose for an elderly patient. I negotiated with the surgeon to give half this dose and we obtained a very satisfactory 'soft' eye. There are potential side effects with mannitol, and I feel that a much reduced dose of mannitol would be safer and equally effective. Any thoughts?
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500 ml x .2= 100 gm. A large dose given in situations where ICP is elevated and impending herniation. While it's well tolerated in most situations, it could precipitate congestive heart failure (temporary increase in intravascular volume) before the osmotic diuresis begins. Also, since it is a single dose(not repeated) it will rarely cause any long lasting electrolytes or osmol changes. Given the lack of urgency, I agree that half the dose would be more than enough. |
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