(FDA approved in bold)

• Reduction of elevated intracranial pressure (ICP)
  
• Reduction of elevated intraocular pressure
  
• Diuresis (prophylaxis in acute renal failure)
  
• Increased excretion of urinary toxins
  
• Urologic irrigation

• Mannitol induces diuresis by elevating the osmolarity of the glomerular filtrate, which decreases tubular reabsorption of water

• 15 minutes

• Assess effectiveness and need for continued use. Usually used as a short-term measure before more definitive treatment

• Usually mannitol is a temporary measure for acute increases in ICP before more definitive treatment

• Treatment of increased ICP depends on the etiology
  
• Causes of increased ICP due to general swelling include liver failure, hypertensive encephalopathy, and hypercarbia. Intervention should consist of treating the underlying medical problem
  
• In some cases, meningitis can cause increased production of CSF or obstruction of CSF flow
  
• Increased ICP due to mass effect from stroke (ischemic or hemorrhagic), may require neurosurgical intervention such as an intraventricular catheter, craniotomy, or craniectomy
  
• Permitting hypertension may increase perfusion and improve swelling, but calcium channel blockers may also be useful (especially in subarachnoid hemorrhage)
  
• Analgesia and sedation may be useful
  
• Hyperventilation, hypothermia, and barbiturate coma are occasionally used, usually in refractory cases
  
• Hypertonic saline is an alternative to mannitol for acutely increased ICP
  
• Corticosteroids are often used to reduce vasogenic edema, i.e., brain tumors

• Carefully monitor serum sodium, potassium, BUN, and urine output during therapy