만니톨

삼투성 이뇨제

만니톨은 주로 응급 및 중환자 수의학에서 사용되는 강력한 **삼투성 이뇨제**입니다. 세포 내에서 세포 외 공간으로 수분을 끌어당기는 당알코올입니다. **주요 적응증:** * **급성 핍뇨성 신부전**의 관리 (이뇨 촉진) * **두개내압(ICP)** 및 뇌부종 감소 (예: 외상성 뇌손상) * 급성 녹내장 시 **안압(IOP)** 감소 * 특정 독소(예: 아스피린, 바르비투르산염, 브롬화물, 에틸렌 글리콜)의 요배설 촉진 > **임상 팁:** 만니톨은 빠른 체액 이동을 유발하므로 매우 효과적이지만 환자의 체액 및 수화 상태에 대한 엄격한 모니터링이 필요합니다. 실온에서 결정화되는 경향이 있으므로 반드시 인라인 필터를 사용하여 투여해야 합니다.

작용 기전: Mannitol is freely filtered at the glomerulus and poorly reabsorbed in the renal tubules. * **Osmotic Diuresis:** The presence of mannitol in the tubular fluid increases osmotic pressure → prevents water reabsorption → proportionately increases water excretion along with sodium, uric acid, and urea. * **Neuroprotection & ICP Reduction:** Increases intravascular osmolarity → draws water from brain parenchyma across an intact blood-brain barrier (BBB) into the intravascular space → decreases cerebral edema and CSF pressure. * **Renal Protection:** Dilates renal arterioles → decreases vascular resistance and blood viscosity → increases renal blood flow and glomerular filtration rate (GFR). It also minimizes renal tubular swelling and prevents the concentration of nephrotoxins in tubular fluid.

동물 종별 용량

Sheep

Cerebral edema · 1-3 gram/kg IV · IV · Single dose · Usually given with steroids and/or DMSO.
Oliguric renal failure · 1-2 gram/kg (5-10mL of 20% solution) IV · IV · Single dose · Give after rehydration; monitor urine flow and fluid balance.

Goats

Cerebral edema · 1-3 gram/kg IV · IV · Single dose · Usually given with steroids and/or DMSO.
Oliguric renal failure · 1-2 gram/kg (5-10mL of 20% solution) IV · IV · Single dose · Give after rehydration; monitor urine flow and fluid balance.

Cats

Oliguric renal failure (not anuric) · 0.25-0.5 gram/kg IV over 5-10 minutes · IV · May repeat q4-6 hours or as CRI for first 12-24 hours · 12-24 hours · After correcting fluid, electrolyte, acid/base balance. CRI dose is 8-10% solution.
Oliguric renal failure (rehydrated, not fluid overloaded) · 0.25-0.5 gram/kg IV slowly over 5-10 minutes; repeat dose at 30-40 minute intervals up to 1.5 gram/kg total · IV · q30-40min · Up to 1.5 g/kg total
Oliguric renal failure (fluid replete) · 0.5 gram/kg IV over 20-30 minutes; if significant diuresis is accomplished within 30 minutes, may administer as a CRI of 60-120 mg/kg/hr IV or as intermittent boluses repeated every 4-6 hours · IV · CRI or q4-6h · Contraindicated in patients who are dehydrated, hypervolemic, or anuric.
Acute glaucoma · 0.5-1 gram/kg IV given over 15-20 minutes · IV · Single dose · Withhold water for 3-4 hours. IOP reduction begins in 20-30 mins.

투여 경로

금기

Anuria secondary to renal disease
Severe dehydration
Severe pulmonary congestion or pulmonary edema
Intracranial bleeding (unless during craniotomy - human label)
Disrupted capillary membrane in the brain (can leak into interstitium and worsen edema)
Severe pulmonary congestion
Pulmonary oedema
Intracranial haemorrhage (relative contraindication; labelled 'use with care' but commonly used in traumatic brain injury)

이상반응

Fluid and electrolyte imbalances (especially hypernatremia)
Volume overload (if oliguria persists)
Nausea and vomiting
Pulmonary edema
Congestive heart failure (CHF)
Tachycardia
Dizziness and headache (CNS effects)
Fluid and electrolyte imbalances
Circulatory overload (at high doses)
Acidosis (at high doses)
Thrombophlebitis
Extravasation injury (oedema and skin necrosis)
Diarrhoea (if administered orally)
Acute renal failure (rare)

약물 상호작용

Lithium · Mannitol can increase the renal elimination of lithium
Sotalol · Mannitol's effects on potassium and magnesium may increase the risk for QT prolongation
Potassium-depleting diuretics · May exacerbate diuretic-induced hypokalaemia · moderate
Beta-blockers · Concurrent use with potassium-depleting diuretics requires caution · moderate
Ciclosporin · Nephrotoxicity has been described with concurrent use in humans · major
Whole blood · Mannitol should never be added to whole blood for transfusion or given through the same IV set · major
KCl or NaCl · Do not add to concentrated mannitol solutions (20% or 25%) as a precipitate may form · major

모니터링

Serum electrolytes (especially sodium)
Serum osmolality
BUN and serum creatinine
Urine output
Central venous pressure (CVP), if possible
Lung auscultation (to monitor for pulmonary edema)
Intracranial pressure (ICP) or neurological status
Intraocular pressure (IOP)
Hydration status and body weight
Serum electrolytes (especially potassium and sodium)
Renal function (BUN, creatinine)
Acid-base balance

과용량

Inadvertent overdosage can cause excessive excretion of sodium, potassium, and chloride. If urine output is inadequate, **water intoxication** or **pulmonary edema** may occur. **Treatment:** * Halt mannitol administration immediately. * Monitor and correct electrolyte and fluid imbalances. * Hemodialysis is effective in clearing mannitol from the bloodstream.

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