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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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Accepted: March 14, 1967
Received: December 16, 1966
☆Supported by Grant HE 5684-01 and the Medical College Kidney Research Fund.
© 1967 Published by Elsevier Inc.