In a head injury patient, Mannitol should not be used for control of increased intracranial pressure when
Mannitol Mannitol is widely used to reduce ICP Commonly used preparation : 20% solution, 0.25-1 gm/kg is given IV as bolus. Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failure Uses of Mannitol To reduce increased ICT or intra ocular tension To maintain GFR and urine flow in impending renal failure Forced diuresis in hypnotic or other poisoning To counteract low osmolality of plasma/ECF due to rapid haemodialysis or peritoneal dialysis Contraindications of Mannitol Acute tubular necrosis Anuria Pulmonary edema Acute left ventricular failure. CHF Cerebral hemorrhage Ref: Harrison's 19th edition Pgno : 1779-1780
Serum osmolality is more than 320 mOsmol/kg
Aerial PaCO2 is less than 34 mm Hg
Aerial PaO2 is more than 100 mg Hg
Aerial pH is less than 7.35
General surgery