Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Gilad Segev, Cheryl Stafford, John Kirby, Larry D Cowgill

Research output: Contribution to journalArticle

Abstract

Introduction: Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives: To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods: Prospective cross-over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7-day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5% dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results: For all protocols, urine production significantly (P <.001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short-lived. Conclusions: Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.

Original languageEnglish (US)
JournalJournal of Veterinary Internal Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

glomerular filtration rate
Mannitol
mannitol
Glomerular Filtration Rate
Electrolytes
electrolytes
urine
excretion
Urine
injection
Injections
Dogs
renal function
urea nitrogen
Acute Kidney Injury
Cross-Over Studies
solutes
Urea
dogs
Osmotic Diuretics

Keywords

  • acute kidney injury
  • chronic kidney disease
  • diuretics
  • dog

ASJC Scopus subject areas

  • veterinary(all)

Cite this

@article{4792b50ed87e4f689f59c72e6602388f,
title = "Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration",
abstract = "Introduction: Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives: To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods: Prospective cross-over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7-day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5{\%} dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results: For all protocols, urine production significantly (P <.001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short-lived. Conclusions: Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.",
keywords = "acute kidney injury, chronic kidney disease, diuretics, dog",
author = "Gilad Segev and Cheryl Stafford and John Kirby and Cowgill, {Larry D}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jvim.15490",
language = "English (US)",
journal = "Journal of Veterinary Internal Medicine",
issn = "0891-6640",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

AU - Segev, Gilad

AU - Stafford, Cheryl

AU - Kirby, John

AU - Cowgill, Larry D

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives: To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods: Prospective cross-over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7-day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5% dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results: For all protocols, urine production significantly (P <.001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short-lived. Conclusions: Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.

AB - Introduction: Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives: To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods: Prospective cross-over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7-day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5% dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results: For all protocols, urine production significantly (P <.001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short-lived. Conclusions: Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.

KW - acute kidney injury

KW - chronic kidney disease

KW - diuretics

KW - dog

UR - http://www.scopus.com/inward/record.url?scp=85063648291&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063648291&partnerID=8YFLogxK

U2 - 10.1111/jvim.15490

DO - 10.1111/jvim.15490

M3 - Article

C2 - 30927388

AN - SCOPUS:85063648291

JO - Journal of Veterinary Internal Medicine

JF - Journal of Veterinary Internal Medicine

SN - 0891-6640

ER -