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Mannitol vs Hypertonic Saline for ICP Management - #MEDSHED

Updated: Nov 14, 2023

Welcome to the #MEDSHED! Needing a brief, concise review of clinical pharmacotherapy and disease management? Direct links of reference to content discussed? Look no further than the #MEDSHED series based on infographics and carousel presentations!



👻 Mannital vs Hypertonic Saline for ICP Management - #MEDSHED

🥗 Elevated intracranial pressures can be from traumatic brain injuries and other neurologic abnormalities resulting in cerebral edema. Both mannitol and hypertonic saline effectively reduce intracranial pressure.

When compared to either, there has been no proven difference in improved clinical outcomes or mortality. However, current evidence leans towards hypertonic saline being associated with a more rapid and sustained control of ICP.

🌊 Mannitol

Mechanism: osmotic diuresis, reduces blood viscosity that transiently increases cerebral blood flow and subsequent reduction in cerebral blood volume

Mannitol 20% 0.5 - 2 gm infused at 0.5 g over 30 - 60 minutes

Monitoring: Volume depletion/dehydration, AKI, shock

👾 Hypertonic saline

Mechanism: increases osmolarity of blood, draws water from brain (decreases overall ICP)

Sodium chloride 3% 250 - 500 mL IV piggyback, 23.4% 30 mL slow IV push

Monitoring: Hypernatremia, extravasation/tissue necrosis

Peripheral administration has shown to be safe in critically ill patients, central line preferred

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Mishra et al. Indian J Pediatr. 2023 Sep;90(9):899-906.

Miyoshi et al. J Intensive Care. 2020 Aug 12;8:61.

"Mannitol." Lexicomp, Wolters Kluwer,

"Sodium chloride preparations." Lexicomp, Wolters Kluwer,

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