Mannitol infusion is being considered for raised intracranial pressure. In which coexisting condition should it be avoided?

• A Chronic hypertension with left ventricular hypertrophy
• B Acute pulmonary edema with elevated left atrial pressure ✓
• C Compensated chronic kidney disease with creatinine 1.6 mg/dL
• D Diabetes mellitus with HbA1c of 8 percent

Explanation

Before its osmotic effect removes water into the urine, mannitol stays in the extracellular compartment and transiently raises plasma osmolality, drawing water out of cells and increasing intravascular volume. This preload surge can precipitate or worsen acute pulmonary edema, so established congestive heart failure with pulmonary congestion is a classic contraindication. Anuric renal failure is the other major contraindication.

Reference: Katzung Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.