Mannitol and ECF expansion
Mannitol is a prototype drug for osmotic diuretics, and it is inert chemical substance which increases osmolarity of blood and renal tubular lumen. This post is about explanation for following question.
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A 78-year-old man with a history of heart disease has difficulty breathing and is diagnosed with acute pulmonary edema. Which drug is contraindicated?
A. Furosemide
B. Nesiritide
C. Mannitol
D. Nitroglycerin
Answer is C Mannitol
Mannitol is contraindicated in Pulmonary edema and Pulmonary congestion.
Mannitol is an osmotic diuretic, it increases osmolarity of blood and extracts fluid from intracellular compartments into Extracellular compartment. This leads to ECF expansion, and volume overload until diuresis begins. People with congestive heart failure and pulmonary edema cannot handle this extracellular fluid expansion, and their condition deteriorate if Mannitol is given to such cases.
Excessive doses of mannitol in smaller time is known to cause pulmonary edema.
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Furosemide
Furosemide is a loop diuretic; it is diuretic of choice in cases with pulmonary edema and heart disease. Loop diuretics are cornerstone of cardiogenic pulmonary edema treatment. Furosemide is used most commonly. Furosemide decreases preload through two main mechanisms: diuresis and venodilation.
Nesiritide
Nesiritide is a recombinant human BNP (Brain Natriuretic Peptide). it has venous, arterial, and coronary vasodilatory properties that reduce preload and afterload, and it increases cardiac output. it decreases pulmonary capillary wedge pressure and so it is used to improve breathing in people with heart failure and pulmonary edema.
Nitroglycerin
Nitroglycerin (NTG) is an important preload reducer and thus it is very useful drug in acute pulmonary edema, and even modestly reduces afterload with high doses so it is very helpful in cases with volume strain on heart.
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