Volume replacement is associated with a diminished osmolar effect of mannitol in patients with acute brain injury
Issued Date
2022-12-01
Resource Type
ISSN
10523057
eISSN
15328511
Scopus ID
2-s2.0-85142402641
Pubmed ID
36334372
Journal Title
Journal of Stroke and Cerebrovascular Diseases
Volume
31
Issue
12
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Stroke and Cerebrovascular Diseases Vol.31 No.12 (2022)
Suggested Citation
Migdady I., Roy A., Duskin J.A., McKeown M.E., Fischer D., Barra M.E., Schontz M., Wongboonsin J., Bevers M.B., Arnaout O., Izzy S., Snider S.B. Volume replacement is associated with a diminished osmolar effect of mannitol in patients with acute brain injury. Journal of Stroke and Cerebrovascular Diseases Vol.31 No.12 (2022). doi:10.1016/j.jstrokecerebrovasdis.2022.106867 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85221
Title
Volume replacement is associated with a diminished osmolar effect of mannitol in patients with acute brain injury
Other Contributor(s)
Abstract
Introduction: Animal experiments recently demonstrated that replacing urinary loses with crystalloid diminishes the therapeutic effect of mannitol by reducing the increase in osmolality. We aimed to investigate whether this effect is similarly seen in in brain-injured patients by studying the association between total body fluid balance (TBB) and the osmolar response to mannitol. Methods: We performed a retrospective cohort study of adult patients with acute brain injury between 2015 and 2021 who received ≥ 2 doses of mannitol within 8 hours and no intercurrent concentrated saline solution. We analyzed the association between the change in TBB (∆TBB) and change in osmolality (∆Osm) before and after mannitol in a linear model, both as univariate and after adjustment for common confounding factors. Results: Of 6,145 patients who received mannitol, 155 patients met inclusion criteria (mean age 60 ± 17 years, 48% male, 83% white). The mean total mannitol dose was 2 ± 0.5 g/kg and the mean change in plasma osmolality was 7.9 ± 7.1 mOsm/kg. Each 1 L increase in ∆TBB was associated with a change of -1.1 mOsm/L in ∆Osm (95% CI [-2.2, -0.02], p = 0.045). The magnitude of association was similar to that of total mannitol dose and remained consistent in an adjusted model and after excluding outliers. Conclusions: In patients with acute brain injury, a positive TBB is associated with a diminished mannitol-induced increase in plasma osmolality. Future prospective studies are needed to confirm these findings and their influence on the therapeutic effect of mannitol.