Chiumello Davide, Aiello Clara, Pozzi Tommaso, Panina Francesca, Muscas Alessandra, Mancusi Simone, Coppola Silvia
Department of Anesthesia and Intensive Care, ASST Santi Paolo E Carlo, San Paolo University Hospital, Milan, Italy.
Department of Health Sciences, University of Milan, Milan, Italy.
Intensive Care Med Exp. 2025 Sep 16;13(1):96. doi: 10.1186/s40635-025-00807-y.
Mannitol is the most commonly used osmotic diuretic, but its effect on plasma and urine electrolytes and on acid-base equilibrium have not been well investigated. The aim of this study was to evaluate the short-term effects of mannitol on diuresis and plasma and urine acid-base equilibrium in a group of critically ill patients according to the Stewart approach.
Prospective observational study enrolling all consecutive sedated and mechanically ventilated patients requiring mannitol infusion for clinical purpose. Plasma and urine acid-base variables and electrolytes were measured before mannitol infusion and every 60 and 30 min, respectively, following the infusion of 1 g/kg of ideal body weight of mannitol. Forty-two patients were enrolled. Diuresis increased significantly 30 min after the mannitol infusion was completed and remained significantly higher as compared with T. Plasma sodium and chloride concentrations and plasma SID significantly decreased after mannitol infusion ended; urine sodium and chloride concentration remained unchanged, while urine ammonium increased increasing urine SID.
Since the end of the infusion, mannitol promoted a significant increase in diuresis, with a reduction in plasma electrolytes due to volume expansion, and a slight decrease in arterial pH due to dilutional acidosis. Kidney relative excretion pattern was unmodified during the study.
甘露醇是最常用的渗透性利尿剂，但其对血浆和尿液电解质以及酸碱平衡的影响尚未得到充分研究。本研究的目的是根据斯图尔特方法评估甘露醇对一组危重病患者利尿作用以及血浆和尿液酸碱平衡的短期影响。
前瞻性观察性研究纳入了所有因临床目的需要输注甘露醇的连续镇静和机械通气患者。在输注1g/kg理想体重的甘露醇之前以及输注后分别每60分钟和30分钟测量血浆和尿液酸碱变量及电解质。共纳入42例患者。甘露醇输注完成后30分钟利尿显著增加，与输注前相比仍显著升高。甘露醇输注结束后血浆钠、氯浓度及血浆强离子差显著降低；尿钠和氯浓度保持不变，而尿铵增加，尿强离子差增加。
自输注结束后，甘露醇促使利尿显著增加，因容量扩张导致血浆电解质减少，因稀释性酸中毒导致动脉pH略有下降。研究期间肾脏相对排泄模式未改变。
