| Customization: | Available |
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| Application: | Internal Medicine |
| Usage Mode: | For external use |
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The main ingredients of this product and its chemical name are: Mannitol (D-mannitol)
Molecular formula: C6H14O6
Molecular weight: 128.17
[Properties] This product is a colorless, clear liquid.
[Pharmacology and Toxicology]
Mannitol is a monosaccharide, which is not metabolized in the body. After being filtered by the glomerulus, it is rarely reabsorbed in the renal tubules and plays a role of osmotic diuresis.
(1) Tissue dehydration. Increasing plasma osmotic pressure causes water in tissues (including eyes, brain, cerebrospinal fluid, etc.) to enter blood vessels, thereby reducing tissue edema, reducing intraocular pressure, intracranial pressure, and cerebrospinal fluid volume and pressure. 1g of mannitol can produce an osmotic concentration of 5.5mOSm. Injection of 100g of mannitol can transfer 2000ml of intracellular water to the outside of the cell, and excrete 50g of sodium in urine.
(2) Diuretic effect. The diuretic mechanism of mannitol is divided into two aspects. Mannitol increases blood volume and promotes the secretion of prostaglandin I2, thereby expanding renal blood vessels and increasing renal blood flow including renal medulla blood flow. The glomerular small arteries expand, the glomerular capillary pressure increases, and the cortical glomerular filtration rate increases. The drug is rarely reabsorbed by the renal tubules after filtration from the glomerulus (<10%), so it can increase the osmotic concentration of the fluid in the renal tubules and reduce the renal tubule water and Na+, Cl-, K+, Ca2+, Mg2+ and others Reabsorption of solute.
Due to the increase in renal tubular fluid flow after mannitol infusion, when certain drugs and poisons are poisoned, the concentration of these substances in the renal tubules decreases, the toxicity to the kidneys is reduced, and the excretion through the kidneys is accelerated.
[Pharmacokinetics]
Mannitol is rarely absorbed orally. After intravenous injection, it quickly enters the extracellular fluid without entering the cell. But when the blood mannitol concentration is high or there is acidosis, mannitol can pass through the blood-brain barrier and cause a rebound of intracranial pressure. The diuretic effect appeared 1 hour after the intravenous injection and maintained for 3 hours. The effect of reducing intraocular pressure and intracranial pressure appears within 15 minutes after intravenous injection, and the peak time is 30-60 minutes, and it is maintained for 3-8 hours. The amount of this medicine that can be metabolized by the liver is small. T1/2 of this medicine is 100 minutes, which can be extended to 6 hours when there is acute renal failure. When renal function is normal, 100g of mannitol is injected intravenously, and 80% is excreted through the kidneys within 3 hours.
[Indications]
(1) Tissue dehydration medicine. It is used to treat brain edema caused by various reasons, reduce intracranial pressure and prevent brain herniation.
(2) Reduce intraocular pressure. It can effectively reduce intraocular pressure and is used when other intraocular pressure lowering drugs are ineffective or in preparation for intraocular surgery.
(3) Osmotic diuretics. Used to identify prerenal factors or oliguria caused by acute renal failure. It can also be used to prevent acute tubular necrosis caused by various reasons.
(4) As an auxiliary diuretic measure to treat nephrotic syndrome, liver cirrhosis and ascites, especially when accompanied by hypoproteinemia.
(5) For certain drugs overdose or poisoning (such as barbiturates, lithium, salicylate and bromide, etc.), this drug can promote the excretion of the above substances and prevent nephrotoxicity.
(6) As a flushing agent, it is used for transurethral prostatectomy.
(7) Preoperative bowel preparation.
[Dosage]
1. Common dosage for adults
(1) Diuretic. The usual dosage is 1~2g/Kg according to body weight, generally 250ml of 20% solution is used for intravenous drip, and the dosage is adjusted to maintain the urine output at 30~50ml per hour.
(2) Treat cerebral edema, intracranial hypertension and glaucoma. According to the weight of 0.25~2g/Kg, it is formulated as a 20% concentration for intravenous infusion within 30~60 minutes. When the patient is weak, the dose should be reduced to 0.5g/Kg. Follow up renal function closely.
(3) Differentiate prerenal oliguria and renal oliguria. According to body weight 0.2g/Kg, intravenous infusion within 3~5 minutes at a concentration of 20%, if the urine output is still less than 30~50ml per hour after 2~3 hours after the medication, try again at most, if there is still no response The drug should be discontinued. People who already have hypofunction or heart failure should use it with caution or not.
(4) Prevent acute tubular necrosis. First give 12.5~25g, intravenous drip within 10 minutes, if there is no special circumstances, then give 50g, intravenous drip within 1 hour, if the urine output can be maintained above 50ml per hour, you can continue to use 5% solution intravenous drip; If ineffective, stop the drug immediately.
(5) Therapeutic drugs and poisoning. 50g is intravenously infused with a 20% solution, and the dosage is adjusted to maintain the urine output at 100~500ml per hour.
(6) Intestinal preparation. 4 to 8 hours before surgery, 1000ml of 10% solution was taken orally within 30 minutes.
2. Commonly used amounts in children
(1) Diuretic. According to body weight 0.25~2g/Kg or body surface area 60g/m2, 20% solution is intravenously infused within 2-6 hours.
(2) Treat cerebral edema, intracranial hypertension and glaucoma. According to body weight 1~2g/Kg or according to the surface area of 30~60g/m2, 20% concentration solution is intravenously infused within 30~60 minutes, and the dose is reduced to 0.5g/Kg when the patient is weak.
(3) Differentiate prerenal oliguria and renal oliguria. According to body weight 0.2g/kg or body surface area 6g/m2, intravenous infusion at 20% concentration for 3~5 minutes. If there is no significant increase in urine output after 2~3 hours of medication, it can be used again, if there is still no response, no reuse.
(4) Therapeutic drugs and poisoning. According to body weight 2g/kg or body surface area of 6g/m2 with 5~10% solution intravenous drip.
[Adverse reactions]
(1) Disorders of water and electrolytes are the most common: Rapid and large amounts of intravenous mannitol can cause mannitol to accumulate in the body, and blood volume increases rapidly (especially in acute and chronic renal failure), leading to heart failure (especially when heart function is impaired) ), dilutional hyponatremia, can occasionally cause hyperkalemia; Inappropriate excessive diuresis leads to a decrease in blood volume and aggravates oliguria; The transfer of a large amount of intracellular fluid to the outside of the cell can cause tissue dehydration and may cause central Nervous system symptoms.
(2) Chills and fever.
(3) Difficulty urinating.
(4) Thrombophlebitis.
(5) Extravasation of mannitol can cause tissue edema and skin necrosis.
(6) Allergies cause skin rash, urticaria, dyspnea, and anaphylactic shock.
(7) Dizziness and blurred vision.
(8) Hypertonicity causes thirst.
(9) Osmotic nephropathy (or mannitol nephropathy), mainly seen in high-dose rapid intravenous drip. The mechanism has not been fully elucidated, and it may be caused by the excessive increase in osmotic pressure of renal tubular fluid caused by mannitol, which may lead to the damage of renal tubular epithelial cells. The pathological manifestation is the formation of swelling vacuoles in renal tubular epithelial cells. Clinically, there is a decrease in urine output and even acute renal failure. Osmotic nephropathy is common in elderly patients with reduced renal blood flow, low sodium, and dehydration.
[Taboo]
(1) Anuria patients who have been diagnosed with acute tubular necrosis, including those who have not responded to the trial of mannitol, have increased blood volume due to the accumulation of mannitol, which increases the burden on the heart;
(2) Those with severe water loss;
(3) In patients with active intracranial hemorrhage, the bleeding is aggravated by volume expansion, except during intracranial surgery;
(4) Acute pulmonary edema, or severe pulmonary stasis.
[Precautions]
(1) Use with caution in the following situations:
In patients with obvious cardiopulmonary impairment, the sudden increase in blood volume caused by this drug can cause congestive heart failure;
Hyperkalemia or hyponatremia;
Hypovolemia, which may aggravate the condition due to diuresis after application, or make the original hypovolemia concealed by temporary expansion;
Severe renal failure and decreased excretion make the drug accumulate in the body, causing a significant increase in blood volume, aggravating the heart load, and inducing or aggravating heart failure;
Those who cannot tolerate mannitol;
(2) Mannitol tends to crystallize when cold, so it should be carefully checked before use. If it has crystals, it can be placed in hot water or vigorously shaken until the crystals are completely dissolved before use. An infusion set with a filter should be used.
(3) Choose the appropriate concentration according to the condition, and avoid unnecessary use of high concentration and large dose.
(4) High-dose mannitol does not cause diuretic reaction and can significantly increase the plasma osmotic concentration, so hypertonicity should be guarded against.
[Medication for pregnant women and lactating women]
(1) Mannitol can penetrate the placental barrier.
(2) Whether it can be secreted through milk is not clear.
[Medication for elderly patients]
The elderly are more prone to kidney damage when using this drug, and with age, the chance of kidney damage increases. Properly control the dosage.
[medicine interactions]
(1) It can increase the toxic effects of digitalis and is related to hypokalemia.
(2) Increase the diuretic and lower intraocular pressure effects of diuretics and carbonic anhydrase inhibitors, and adjust the dosage when combined with these drugs.
[Drug overdose]
Gastric lavage should be given as soon as possible, support, symptomatic treatment, and close follow-up of blood pressure, electrolytes and renal function.
| Comercial Packing | 10x10's/Box or Customized |
| Production Time | About 30-60days after artwork confirmed |
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