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Intravenous Dilution Guidelines

Mannitol

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

Using 12.5 gram (50 ml vials)
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[12.5 grams] [33ml (tot vol:83ml)] [See below] (15%)
[25 grams ]  [67 ml (tot vol: 167ml)] [ud] (15%)
[50 grams ] [133 ml (tot vol: 333ml)] [ud] (15%)
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[12.5 -100 grams][empty viaflex] See comments

Stability / Miscellaneous

Label: Do not Refrigerate.

Note: Diluted solutions of mannitol are less likely to crystallize, especially if the final concentration is less than 15%. An administration set with a filter should be used for infusions containing 20% or more of mannitol. At concentrations of 15% or greater, mannitol may crystallize at low temperatures.

Dosing:
Oliguria: 50 to 100 grams (15 to 25% soln) over 90 minutes to several hours.

Test dose may be given: 12.5 g over 3 to 5 min. May repeat.
Usual adult dosage ranges (50 to 200 g/ 24hrs).

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DOSAGE AND ADMINISTRATION
This solution is for intravenous use only.

The total dosage, concentration, and rate of administration should be governed by the nature and severity of the condition being treated, and the patient's fluid requirement and urinary output. The adult dosage ranges from 50 to 200 g in a 24-hour period, but in most cases an adequate response will be achieved at a usual dosage of approximately 100 g/24 hours. The rate of administration is usually adjusted to maintain a urine flow of at least 30 to 50 mL/hour. Lower mannitol concentrations and solutions containing sodium chloride are useful in preventing dehydration and electrolyte depletion. This outline of administration and dosage is only a general guide to therapy.

Dosage requirements for patients 12 years of age and under have not been established. As with adults, dose is dependent on weight, clinical condition, and laboratory results. Follow recommendations of appropriate pediatric reference text.

Test Dose
A test dose of mannitol should be given prior to instituting therapy for patients with marked oliguria or those believed to have inadequate renal function. Such test doses may be approximately 0.2 g/kg body weight (about 75 mL of a 20% solution) infused in a period of 3 to 5 minutes to produce a urine flow of at least 30 to 50 mL/hour. If urine flow does not increase, a second test dose may be given. If response is inadequate, the patient should be reevaluated.

Prevention of Acute Renal Failure (Oliguria)
When used during cardiovascular and other types of surgery, 50 to 100 g of mannitol may be given.

Treatment of Oliguria
The usual dose for treatment of oliguria is 100 g administered as a 20% solution.

Reduction of Intraocular Pressure
A dose of 1.5 to 2.0 g/kg as a 20% solution (7.5 to 10 mL/kg) may be given over a period as short as 30 minutes in order to obtain a prompt and maximal effect. When used preoperatively the dose should be given one to one and one-half hours before surgery to achieve maximal reduction of intraocular pressure before operation.

Reduction of Intracranial Pressure
Usually a maximum reduction in intracranial pressure in adults can be achieved with a dose of 0.25 g/kg given not more frequently than every six to eight hours. An osmotic gradient between the blood and cerebrospinal fluid of approximately 10 mOsmol will yield a satisfactory reduction in intracranial pressure.

Adjunctive Therapy for Intoxications
As an agent to promote diuresis in intoxications, mannitol is indicated. The concentration will depend upon the fluid requirement and urinary output of the patient.

Measurement of glomerular filtration rate by creatinine clearance may be useful for determination of dosage.
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It is recommended that 20% Mannitol Injection USP be administered through a blood filter set to ensure against infusion of mannitol crystals.

When a hypertonic solution is to be administered peripherally, it should be slowly infused through a small bore needle, placed well within the lumen of a large vein to minimize venous irritation. Carefully avoid infiltration.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Use of a final filter is recommended during administration of all parenteral solutions, where possible.

This solution is intended for intravenous administration using sterile equipment.

The use of supplemental additive medication is not recommended.

HOW SUPPLIED
20% Mannitol Injection USP is supplied sterile and nonpyrogenic in EXCEL® Containers. The 500 mL and 250 mL containers are packaged 24 per case.
NDC Cat. No. Size
20% Mannitol Injection USP
0264-7578-10 L5781 500 mL
0264-7578-20 L5782 250 mL

Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. Protect from freezing. It is recommended that the product be stored at room temperature (25°C).

Rx only
Rev: December 2005

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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