Classifications: electrolytic and water balance agent; osmotic diuretic; Therapeutic: osmotic diuretic
Pregnancy Category: C
5%, 10%, 15%, 20%, 25% injection
In large doses, increases rate of electrolyte excretion by the kidney, particularly sodium, chloride, and potassium. Induces
diuresis by raising osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes.
Reduces elevated intraocular and cerebrospinal pressures by increasing plasma osmolality, thus inducing diffusion of water
from these fluids back into plasma and extravascular space.
Parenteral osmotic diuretic that reduces intracranial pressure, cerebral edema, intraocular pressure, and promotes diuresis,
thus preventing or treating oliguria.
To promote diuresis in prevention and treatment of oliguric phase of acute kidney failure following cardiovascular surgery,
severe traumatic injury, surgery in presence of severe jaundice, hemolytic transfusion reaction. Also used to reduce elevated
intraocular (IOP) and intracranial pressure (ICP), to measure glomerular filtration rate (GFR), to promote excretion of
toxic substances, to relieve symptoms of pulmonary edema, and as irrigating solution in transurethral prostatic reaction
to minimize hemolytic effects of water. Commercially available in combination with sorbitol for urogenital irrigation.
Anuria; severe renal failure with azotemia or increasing oliguria; marked pulmonary congestion or edema; severe CHF; metabolic
edema; hypovolemia; organic CNS disease, intracranial bleeding; shock, severe dehydration, history of allergy; pregnancy
(category C), lactation; concomitantly with blood.
Older adult; electrolyte imbalance.
Route & Dosage
|Acute Kidney Failure
Adult: IV Test Dose 0.2 g/kg over 35 min Positive Response 3050 mL of urine over next 23 h, may repeat test dose 1 time. If still negative, do not use. Treatment 50100 g as 1520% solution over 90 min to several hours
Child: IV Test Dose 200 mg/kg (max: 12.5 g) over 35 min Positive Response Urine flow of 1 mL/kg/h for 12 h Maintenance 0.250.5 g/kg q46 h
Adult: IV 100 g as a 1020% solution over 26 h
Elevated IOP or ICP
Adult: IV 1.52 mg/kg as a 1525% solution over 3060 min
Acute Chemical Toxicity
Adult: IV 100200 g depending on urine output
Measurement of GFR
Adult: IV 100 mL of 20% solution diluted with 180 mL NaCl injection infused at a rate of 20 mL/min
- Note: Verify correct IV concentration and rate of infusion for administration to infants, children with physician.
PREPARE: IV Infusion: Give undiluted.
ADMINISTER: IV Infusion: Give a single dose over 3090 min. Oliguria: A test dose is given to patients with marked oliguria to check adequacy
of kidney function. Response is considered satisfactory if urine flow of at least 3050 mL/h is produced over 23
h after drug administration; then rate is adjusted to maintain urine flow at 3050 mL/h with a single dose usually
being infused over ≥90 min. Concentrations higher than 15% have a greater
tendency to crystallize. Use an administration set with an in-line IV filter when infusing concentrations of 15% or
INCOMPATIBILITIES Solution/additive: Furosemide, imipenem-cilastatin, meropenem, potassium chloride, sodium chloride, whole blood. Y-site: Cefepime, doxorubicin liposome, filgrastim.
- Store at 15°30° C (59°86° F) unless otherwise directed. Avoid freezing.
Adverse Effects (≥1%)CNS:
Headache, tremor, convulsions, dizziness, transient muscle rigidity. CV:
Edema, CHF, angina-like pain, hypotension, hypertension, thrombophlebitis. Eye:
Blurred vision. GI:
Dry mouth, nausea, vomiting. Urogenital:
Marked diuresis, urinary retention, nephrosis, uricosuria. Metabolic: Fluid and electrolyte imbalance,
; dehydration, acidosis. Other:
With extravasation (local edema, skin necrosis; chills, fever, allergic reactions).
Increases urinary excretion of lithium, salicylates
, imipramine, potassium.
13 h diuresis; 3060 min IOP; 15 min ICP. Duration:
46 h IOP; 38 h ICP. Distribution:
Confined to extracellular space; does not cross bloodbrain barrier except with very high plasma
levels in the presence
of acidosis. Metabolism:
Small quantity metabolized to glycogen in liver. Elimination:
Rapidly excreted by kidneys. Half-Life:
Assessment & Drug Effects
- Take care to avoid extravasation. Observe injection site for signs of inflammation or edema.
- Lab tests: Monitor closely serum and urine electrolytes and kidney function during therapy.
- Measure I&O accurately and record to achieve proper fluid balance.
- Monitor vital signs closely. Report significant changes in BP and signs of CHF.
- Monitor for possible indications of fluid and electrolyte imbalance (e.g., thirst, muscle cramps or weakness, paresthesias,
and signs of CHF).
- Be alert to the possibility that a rebound increase in ICP sometimes occurs about 12 h after drug administration. Patient
may complain of headache or confusion.
- Take accurate daily weight.
Patient & Family Education
- Report any of the following: Thirst, muscle cramps or weakness, paresthesia, dyspnea, or headache.
- Family members should immediately report any evidence of confusion.