MANNITOL-INDUCED ACUTE-RENAL-FAILURE

Mannitol is widely used because of its osmotic diuretic action and its presumed antioxidant properties. In pre-existent renal dysfunction, h owever, mannitol may accumulate leading to potentially deleterious eff ects. We describe a 71-year-old woman with moderate chronic renal fail ure due to diabetic nephropathy who developed acute anuric renal failu re after mannitol administration for post-traumatic reflex sympathetic dystrophy. After haemodialysis symptoms of acute renal failure rapidl y disappeared with recovery of pre-existent renal function. Daily meas urement of the osmolal gap as a simple and accurate way of monitoring patients receiving mannitol infusion is emphasized. A rapid increase i n the osmolar gap should prompt adjustment of the dose or even discont inuation of mannitol, especially in the case of pre-existent risk fact ors.