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.
Keywords
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Article info
Publication history
Published online: November 02, 2022
Accepted:
October 26,
2022
Received in revised form:
October 24,
2022
Received:
August 25,
2022
Footnotes
Institutions where work was done: Massachusetts General Hospital, Brigham and Women's Hospital
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106867
Copyright
© 2022 Elsevier Inc. All rights reserved.
