The Comparison of Two Different Doses of Mannitol on Creatine Phosphokinase (CPK) Reduction in Brain-Death Patients Who Candidates for Organ Donation: A Clinical Trial Study

Document Type : Original Article (s)

Authors

1 Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aims of this study were to compare the effects of two doses of 0.4 and 0.6 mg/kg mannitol on the rate of diuresis, residual renal function, hemodynamic changes and creatine phosphokinase changes in brain death patients.
Methods: In a single-blind randomized clinical trial study on brain death patients hospitalized in the intensive care units of Al-Zahra Hospital in Isfahan, 30 brain death patients were divided into two groups of 15, the first group was given 0.4 g/kg mannitol and the second group was given 0.6 g/kg mannitol with 1 mEq of sodium bicarbonate per kg for 20 minutes. And these values were repeated up to three times every 8 hours. Creatine phosphokinase levels were measured 8 hours after each dose of mannitol and urinary output 2 and 8 hours after each dose of mannitol and renal function, 8 hours after the last dose, and the mean changes were compared between the two groups.
Findings: Mean changes in serum creatine phosphokinase level were significantly decreased in the two groups, but the rate of reduction was not significantly different between the two groups. Glomerular filtration rate was significantly increased in both groups, but the rate of change was not different between the two groups. Also, changes in urinary output were significantly different between the two groups.
Conclusion: The use of 0.6 g / kg of mannitol is not superior to the dose of 0.4 g / kg of this drug in improving renal function and reducing creatinine phosphokinase levels.

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  1. Blasco V, Leone M, Bouvenot J, Geissler A, Albanèse J, Martin C. Impact of intensive care on renal function before graft harvest: results of a monocentric study. Crit Care 2007; 11(5): R103.
  2. Pastore Neto M, Gonçalves RV, Machado CJ, Resende V. Factors associated with changes in creatine phosphokinase (CPK) in trauma patients submitted to the "Red Wave", with evolution to rhabdomyolysis. Rev Col Bras Cir 2018; 45(2): e1604.
  3. Nielsen FE, Cordtz JJ, Rasmussen TB, Christiansen CF. The association between rhabdomyolysis, acute kidney injury, renal replacement therapy, and mortality. Clinical Epidemiology 2020; 12: 989.
  4. Nielsen JS, Sally M, Mullins RJ, Slater M, Groat T, Gao X, et al. Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited. Am J Surg 2017; 213(1): 73-9.
  5. Somagutta MR, Pagad S, Sridharan S, Nanthakumaran S, Arnold AA, May V, et al. Role of bicarbonates and mannitol in rhabdomyolysis: A comprehensive review. Cureus 2020; 12(8): e9742.
  6. Andrews RJ, Bringas JR, Muto RP. Effects of mannitol on cerebral blood flow, blood pressure, blood viscosity, hematocrit, sodium, and potassium. Surg Neurol 1993; 39(3): 218-22.
  7. Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine (Baltimore) 2020; 99(35): e21655.
  8. Aldman A, Lewis DH, Elfström J, Mårtensson J, Larsson J. The effect of mannitol on reperfusion after severe induced subtotal ischemia of the leg. A hemodynamic, biochemical and metabolic study in a pig hind limb model. Int Angiol 1994; 13(3): 246-50.
  9. Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine (Baltimore) 2020; 99(35): e21655.
  10. Sorani MD, Morabito D, Rosenthal G, Giacomini KM, Manley GT. Characterizing the dose-response relationship between mannitol and intracranial pressure in traumatic brain injury patients using a high-frequency physiological data collection system. J Neurotrauma 2008; 25(4): 291-8.
  11. Nincevic Z, Mestrovic J, Nincevic J, Sundov Z,
    Kuscevic D. Low-dose mannitol (0.3 g kg(-1)) improves the pulsatility index and minimum diastolic blood flow velocity in traumatic brain injury. Brain Inj 2015; 29(6): 766-71.
  12. Tan G, Zhou JY, Mao YC, Liu BW, Liao Q. [Most effective daily dose and use method of mannitol in patients with cerebral hemorrhage at acute stage [in Chinese]. Zhonghua Yi Xue Za Zhi 2008; 88(13): 889-91.
  13. Bebawy JF, Ramaiah VK, Zeeni C, Hemmer LB, Koht A, Gupta DK. The effect of furosemide on intravascular volume status and electrolytes in patients receiving mannitol: an intraoperative safety analysis. J Neurosurg Anesthesiol 2013; 25(1): 51-4.
  14. Lee YJ, Park S, Kim YW, Park KM, Kim IH, Park JH, et al. Rhabdomyolysis with peripheral neuropathy: a case series and literature review. Am J Case Rep 2018; 19: 1272-8.
  15. HitawalaAA, Garg P, Jain A, Nahar Severe hypokalemia mimicking brain death. Indian J Crit Care Med 2018; 22(9): 674-7.
  16. Francony G, Fauvage B, Falcon D, Canet C, Dilou H, Lavagne P, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med 2008; 36(3): 795-800.
  17. Gottschalk A, Toung TJK. Effects of volume replacement for urinary losses from mannitol diuresis on brain water in normal rats. Neurocrit Care 2021; 35(1): 24-9.
  18. Gotoh O, Asano T, Koide T, Takakura K. Ischemic brain edema following occlusion of the middle cerebral artery in the rat. I: The time courses of the brain water, sodium and potassium contents and blood-brain barrier permeability to 125I-albumin. Stroke 1985; 16(1): 101-9.
  19. Zhang W, Neal J, Lin L, Dai F, Hersey DP, McDonagh DL, et al. Mannitol in critical care and surgery over 50+ years: a systematic review of randomized controlled trials and complications with meta-analysis. J Neurosurg Anesthesiol 2019; 31(3): 273-84.
  20. Khazimeh B, Mahdavi R, Yeganeh MA. Evaluation of an emergency diuresis in 368 cases of renal transplant anesthesia from Imam Reza Hospital [in Persian]. Med J Mashhad Univ Med Sci 2012; 44(1): 23-9.