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Posted by weran from IP on July 05, 2012 at 19:25:08:

In Reply to: THE ANSWER SURPRISED ME! posted by Eureka on May 22, 2012 at 14:28:34:

mannitol (1 g/kg IV immediately)
Mannitol is sometimes dramatically effective in
reversing acute brain swelling, but its effectiveness
in the on-going management of severe head injury
remains open to question. There is evidence that, in
prolonged dosage, mannitol may pass from the blood into
the brain, where it might cause reverse osmotic shifts
that increase intracranial pressure.
Its osmotic properties take effect in 15-30 minutes
when it sets up an osmotic gradient and draws water out
of neurons. However after prolonged administration
(continuous infusion) mannitol molecules move across
into the cerebral interstitial space and may exacerbate
cerebral oedema and raise ICP. Mannitol itself directly
contributes to this breakdown of the blood brain

Mannitol is therefore best used by bolus administration
where an acute reduction in ICP is necessary. For
example the patient with signs of impending herniation
(unilateral dilated pupil / extensor posturing) or with
an expanding mass lesion may benfit from mannitol to
acutely reduce ICP during the time necessary for CT
scanning and/or operation.

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