Mannitol: Effects, Uses & Risks

Mannitol is a drug that belongs to the active substance class of diuretics. Mannitol is the most commonly used osmodiuretic for the prophylactic treatment of renal failure.

What is mannitol?

Mannitol is the most commonly used osmodiuretic for the prophylactic treatment of renal failure. Mannitol, also known as mannitol, is a sugar alcohol (noncyclic polyols) chemically and structurally derived from mannose. The mannose are pairs of diastereoisomers of a molecule of glucose. The name of the sugar alcohol mannitol comes from the sweet sap of the manna ash tree. The dried sap of the manna ash contains a mannitol content of about 13 percent. The occurrence of mannitol in nature is relatively common, compared to other drugs in this class of compounds. For example, mannitol is found in oil tree plants, brown root plants, fungi and lichens. The highest levels of mannitol have been found in seaweed, larch, olive and fig trees. There, the mannitol content can be as high as 20 percent, with brown algae having a content of up to 40 percent. Mannitol is the product of the hydrogenation of fructose (fruit sugar).

Pharmacological action

Mannitol finds application in the field of food industry as a sweetener, which is labeled as additive E421. It has a sweetening power of up to 69 percent. In addition to its application in the food industry, mannitol is also used as a drug in the pharmaceutical industry. It belongs to the active ingredient class of diuretics and has a solid aggregate state. As an osmodiuretic, mannitol has the advantage that it cannot be converted into an intermediate product by chemical processes of the body (by metabolism). The mannitol enters the bloodstream as foreign to the organism and can thus decompose and break down organism-own substances through dissimilation. It is therefore glomerularly filtered (by the renal corpuscles) and not tubularly reabsorbed (urinary tract). As a result, the active ingredient has a diuretic and laxative function. Therefore, the agent should not be prescribed in the presence of urinary dysfunction or cardiac decompensation (decreased cardiac output). Mannitol therapy should also be avoided in the presence of bloodbrain barrier disruption, intracranial hemorrhage, or pulmonary edema, and an alternative should be considered if appropriate.

Medical Application and Use

In medicine, mannitol is used in the form of tablets, solutions (oral), infusion, or inhalation. The most common use is to prevent acute kidney failure due to blood or fluid loss (dehydration) after injuries such as burns, shock, or after surgery. It also reduces eye and intracranial pressure. In cases of poisoning, mannitol supports detoxification and thus the elimination of the harmful substance. In addition to prophylactic and acute use, mannitol can be administered orally in the form of a solution as a contrast agent, for example in imaging examinations of the gastrointestinal tract. Scientific studies show that mannitol can also be helpful in cystic fibrosis and COPD disorders. For example, the active ingredient liquefies mucus deposits in the bronchial tubes and enables secretions to be cleared by positively changing their viscosity (viscosity).

Risks and side effects

During the use of mannitol, various side effects may occur. These take different forms, depending on the form of intake. When taking tablets should always be considered that the active ingredient affects the mineral and fluid balance. This can result in dehydration, acute kidney failure, tachycardia or cardiac arrhythmia. Further, cardiovascular problems up to complete cardiovascular failure may occur. Gastrointestinal complaints in the form of nausea, vomiting or upper abdominal pain are also common. Severe salt loss and resulting cramps may occur. If mannitol is administered by infusion, severe acute fluid loading may occur. Potentially, this could also lead to cardiovascular failure. When the drug is absorbed by inhalation, side effects often include cough, hemoptysis, headache, chest discomfort, or vomiting. Furthermore, throat and larynx pain may occur.Rarely, a hypersensitivity reaction up to anaphylactic shock, states of confusion, acute kidney failure, fungal infections in the mouth, infections with ]]staphylococcus]]bacteria, dizziness, asthma, earache, pneumonia, acne, itching and urinary incontinence occur. The drug should always be taken under a specialist’s order and monitored seamlessly by laboratory results.