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Abstract
A 33-year-old woman in barbiturate coma, who was given large doses of intravenous
hypertonic mannitol before hemodialysis, deteriorated suddenly during the fourth hour
of hemodialysis. Clinical and necropsy evidence indicated increased intracranial pressure.
To determine whether the rapid removal of mannitol by dialysis might create a bloodbrain
osmotic gradient favoring the development of intracranial edema, dogs were infused
with mannitol and hemodialyzed as the mannitol was stopped. This was associated with
an increase in cerebrospinal fluid pressure (CSFP) which did not occur if the plasma
mannitol concentrations were sustained by continuous infusion or the addition of mannitol
to the dialysate. A similar concentration of glucose did not prevent the CSFP rise.
Increased CSFP was associated with CSF osmolality > plasma osmolality, caused by increased
concentrations of CSF sodium chloride and a rapid reduction of plasma mannitol during
dialysis. The clinical significance of these observations is discussed.
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References
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Article info
Publication history
Accepted:
March 14,
1967
Received:
December 16,
1966
Footnotes
☆Supported by Grant HE 5684-01 and the Medical College Kidney Research Fund.
Identification
Copyright
© 1967 Published by Elsevier Inc.
