Efficacy of hemodialysis and importance of tonicity monitoring in mannitol-induced acute kidney injury with hyponatremia.

IF 0.7 Q4 UROLOGY & NEPHROLOGY
CEN Case Reports Pub Date : 2025-10-01 Epub Date: 2025-06-29 DOI:10.1007/s13730-025-01017-x
Ayaka Soejima, Masatomo Ogata, Ryo Takaki, Takuya Matsuda, Shiika Watanabe, Yugo Shibagaki, Masahiko Yazawa
{"title":"Efficacy of hemodialysis and importance of tonicity monitoring in mannitol-induced acute kidney injury with hyponatremia.","authors":"Ayaka Soejima, Masatomo Ogata, Ryo Takaki, Takuya Matsuda, Shiika Watanabe, Yugo Shibagaki, Masahiko Yazawa","doi":"10.1007/s13730-025-01017-x","DOIUrl":null,"url":null,"abstract":"<p><p>Mannitol is an osmotic diuretic that can induce acute kidney injury (AKI) and hypertonic hyponatremia. Rapid mannitol removal and the avoidance of osmotic demyelination syndrome (ODS) by overcorrecting hyponatremia during dialysis are paramount. We present a case of mannitol-induced AKI and hyponatremia in a man in his 50 s with chronic kidney disease and heart failure who was undergoing chemotherapy for seminoma. After mannitol administration as a part of the chemotherapy protocol for forced diuresis, sudden anuric AKI and subsequent volume expansion developed. An estimated mannitol concentration of 728 mg/dL calculated using the osmolar gap (OG) was treated with hemodialysis (HD). Because of concerns regarding ODS caused by rapid serum sodium (sNa) correction by HD, extracorporeal ultrafiltration was initially considered for volume reduction. However, HD was ultimately chosen for mannitol removal; therefore, instead of the measured sNa, tonicity or corrected sodium (cNa) was monitored to account for transcellular free-water shifts between the intracellular and extracellular compartments. In this case, HD effectively removed mannitol, as reflected by the decreased OG, thereby resolving AKI and hyponatremia. Furthermore, tonicity (or cNa) remained stable throughout treatment, and complications were avoided. Prioritizing tonicity (or cNa) over measured sNa is important when managing hypertonic hyponatremia caused by mannitol intoxication.</p>","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":" ","pages":"746-750"},"PeriodicalIF":0.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457231/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CEN Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13730-025-01017-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/29 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Mannitol is an osmotic diuretic that can induce acute kidney injury (AKI) and hypertonic hyponatremia. Rapid mannitol removal and the avoidance of osmotic demyelination syndrome (ODS) by overcorrecting hyponatremia during dialysis are paramount. We present a case of mannitol-induced AKI and hyponatremia in a man in his 50 s with chronic kidney disease and heart failure who was undergoing chemotherapy for seminoma. After mannitol administration as a part of the chemotherapy protocol for forced diuresis, sudden anuric AKI and subsequent volume expansion developed. An estimated mannitol concentration of 728 mg/dL calculated using the osmolar gap (OG) was treated with hemodialysis (HD). Because of concerns regarding ODS caused by rapid serum sodium (sNa) correction by HD, extracorporeal ultrafiltration was initially considered for volume reduction. However, HD was ultimately chosen for mannitol removal; therefore, instead of the measured sNa, tonicity or corrected sodium (cNa) was monitored to account for transcellular free-water shifts between the intracellular and extracellular compartments. In this case, HD effectively removed mannitol, as reflected by the decreased OG, thereby resolving AKI and hyponatremia. Furthermore, tonicity (or cNa) remained stable throughout treatment, and complications were avoided. Prioritizing tonicity (or cNa) over measured sNa is important when managing hypertonic hyponatremia caused by mannitol intoxication.

甘露醇致急性肾损伤伴低钠血症血液透析的疗效及强直监测的重要性。
甘露醇是一种渗透性利尿剂,可引起急性肾损伤(AKI)和高渗性低钠血症。快速清除甘露醇和避免渗透脱髓鞘综合征(ODS)通过过度纠正透析期间低钠血症是至关重要的。我们报告一例甘露醇引起的AKI和低钠血症,患者为50多岁,患有慢性肾脏疾病和心力衰竭,因精原细胞瘤而接受化疗。甘露醇作为强制利尿化疗方案的一部分后,出现突发性无尿AKI和随后的容量扩张。使用渗透压间隙(OG)计算的甘露醇浓度估计为728 mg/dL,并进行血液透析(HD)治疗。由于担心HD快速修正血清钠(sNa)引起ODS,体外超滤最初被考虑用于体积缩小。然而,HD最终被选择用于甘露醇去除;因此,不是测量sNa,而是监测张力或校正钠(cNa),以解释细胞内和细胞外隔室之间的跨细胞自由水转移。在本例中,HD有效地去除甘露醇,如OG降低所反映的,从而解决了AKI和低钠血症。此外,在整个治疗过程中,张力(或cNa)保持稳定,避免了并发症。当处理甘露醇中毒引起的高渗性低钠血症时,优先考虑强直性(或cNa)而不是测量的sNa是很重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信