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20-September-2008 09:55:49 - Mannitol Mannitol Systematic IUPAC name 2R,3R,4R,5R-Hexane-1,2,3,4,5,6-hexol Identifiers CAS number 69-65-8 ATC code A06AD16 B05BC01 B05CX04 PubChem 453 DrugBank APRD01083 Chemical data Formula C6H14O6 Mol. mass 182.172 Pharmacokinetic data Bioavailability ~7% Metabolism Hepatic, negligible. Half life 100 minutes Excretion Renal: 90% Therapeutic considerations Pregnancy cat. C: USA Legal status ? Routes Intravenous Oral Mannitol or hexan-1,2,3,4,5,6-hexol C6H8OH6 is a polyol that is used as an osmotic diuretic agent and a weak renal vasodilator. It is a sorbitol stereoisomer. It was originally isolated from the secretions of the Flowering Ash, called Manna after their resemblance to the Biblical food, and may also be referred to as Mannite and Manna Sugar.1 Contents 1 Chemical properties 2 Uses 3 Controversy 4 See also 5 References 6 External links Chemical properties Chemically, mannitol is a sugar alcohol, or a polyol; it is similar to xylitol or sorbitol. However, mannitol has a tendency to lose a hydrogen ion in aqueous solutions, which causes the solution to become acidic. For this, it is not uncommon to add a substance to adjust its pH, such as sodium bicarbonate. Uses Mannitol is used clinically to reduce acutely raised intracranial pressure, until more definitive treatment can be given, e.g. after head trauma although significant controversy exists over this use, and to treat patients with oliguric renal failure. It is administered intravenously, and is filtered by the glomerulus of the kidney, but is incapable of being resorbed from the renal tubule, resulting in decreased water and Na+ reabsorption via its osmotic effect. Consequently, mannitol increases water and Na+ excretion, thereby decreasing extracellular fluid volume. Mannitol can also be used to open the blood-brain barrier by temporarily shrinking the tightly coupled endothelial cells that make up the barrier. This makes mannitol indispensable for delivering various drugs directly to the brain e.g. in the treatment of Alzheimer's disease. Mannitol is also used as a sweetener for people with diabetes. Since mannitol has a negative heat of solution, it is used as a sweetener in breath-freshening candies, the cooling effect adding to the fresh feel. In oral doses larger than 20g, mannitol acts as an osmotic laxative, and is sometimes sold as a laxative for children. It is sometimes used as an adulterant or cutting agent for heroin, methamphetamines or other illicit drugs. In popular culture, when it is used in this manner, it is often referred to as baby laxative. Many television shows and films depicting drug culture make references to baby laxative. Mannitol can also be used to temporarily encapsulate a sharp object such as a helix on a lead for an artificial pacemaker while it is passing through the venous system. Because it dissolves readily in blood, the sharp point will become exposed by the time it reaches its destination. Mannitol may be administered in cases of severe Ciguatera poisoning. Severe ciguatoxin, or tropical fish poisoning can produce stroke-like symptoms. Mannitol is a non-permeating molecule; i.e., it cannot cross biological membranes. Mannitol is commonly used in the circuit prime of a heart lung machine during cardiopulmonary bypass CPB. The presence of mannitol preserves renal function during the times of low blood flow and pressure, while the patient is on bypass. The solution prevents the swelling of endothelial cells in the kidney, which may have otherwise reduced blood flow to this area and resulted in cell damage. Mannitol is also being developed by Australian pharmaceutical company Pharmaxis as a treatment for cystic fibrosis and bronchiectasis and as a diagnostic test for airway hyperresponsiveness. The mannitol is orally inhaled as a dry powder through what is known as an osmohaler and osmotically draws water into the lungs to thin the thick, sticky mucus characteristic of cystic fibrosis. This is intended to make it easier for the sufferer to cough the mucus up during physiotherapy. The critical component of the mannitol being the particle size distribution PSD. The company has marketing approval for its diagnostic in Australia and Europe and is currently applying for approval from the FDA. Chemical Abstract Registry Numbers for Mannitol are 123897-58-5 69-65-8 75398-80-0 85085-15-0 Controversy The three studies234 which initially found that high-dose mannitol was effective in cases of severe head injury have been the subject of a recent investigation.5 Although several authors are listed, it is unclear whether the authors had knowledge of how the patients were recruited. Further, the Federal University of São Paulo, which he gave as his affiliation, has never employed him. Currently, therefore, the Cochrane review recommending high-dose mannitol6 has been withdrawn pending re-evaluation, as there is some evidence that mannitol may worsen cerebral edema.7 See also Sorbitol Xylitol References ^ Cooley's Cyclopaedia of Practical Receipts, 6th ed. 1880 ^ Cruz J, Minoja G, Okuchi K. Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery. 2001 Oct;494:864-71. PMID 11564247 ^ Cruz J, Minoja G, Okuchi K. Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery. 2002 Sep;513:628-37; discussion 637-8. PMID 12188940 ^ Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg. 2004 Mar;1003:376-83. PMID 15035271 ^ Roberts I, Smith R, Evans S. Doubts over head injury studies. BMJ. 2007 Feb 24;3347590:392-4. PMID 17322250 ^ Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2005 Oct 19;4:CD001049. PMID 16235278 ^ Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992 Oct;774:584-9. PMID 1527619 External links RXList-osmitrol 1724907529 at GPnotebook v d e Antihypertensives C02 and diuretics C03 Sympatholytic agents Centrally acting/antiadrenergics α2 agonist Clonidine, Guanfacine, Methyldopa imidazoline receptor agonist Moxonidine, Rilmenidine adrenergic uptake inhibitor Rescinnamine, Reserpine Ganglion-blocking/nicotinic antagonist Mecamylamine, Trimethaphan Peripherally acting/antiadrenergics α1 blockers: Prazosin Indoramin Trimazosin Doxazosin Urapidil Guanidine derivatives: Betanidine Guanethidine Guanoxan Debrisoquine Guanoclor Guanazodine Guanoxabenz Vasodilators Diazoxide hydrazinophthalazine Hydralazine, Dihydralazine, Endralazine, Cadralazine Minoxidil Nitroprusside Phentolamine Other antihypertensives serotonin antagonist Ketanserin endothelin receptor antagonist Bosentan, Ambrisentan, Sitaxsentan MAOI Pargyline THI Metirosine Diuretics Low ceiling Thiazides at DCT Bendroflumethiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide Polythiazide Trichlormethiazide Cyclopenthiazide Methyclothiazide Cyclothiazide Mebutizide Sulfonamides Quinethazone Clopamide Chlortalidone Mefruside Clofenamide Metolazone Meticrane Xipamide Indapamide Clorexolone Fenquizone Other Mersalyl Theobromine Cicletanine osmotic Mannitol, Urea carbonic anhydrase inhibitor at PT Acetazolamide High ceiling Loop diuretic at AL Bumetanide, Furosemide, Torasemide, Ethacrynic acid Potassium-sparing at CD ESC blockers Amiloride, Triamterene aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone Retrieved from http://en..org/wiki/Mannitol Categories: Sugar alcohols | Sweeteners | Polyols Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français Galego Italiano Magyar Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Svenska ä¸æ–‡ This page was last modified on 18 August 2008, at 20:57
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