Management of Mannitol in SDH Patients with Hyponatremia

Pathophysiology and Considerations

• Mannitol is a hyperosmolar agent that works by creating an osmotic gradient to reduce cerebral edema and intracranial pressure (ICP) in patients with subdural hematoma (SDH) 1

Treatment Algorithm for SDH with Hyponatremia

• Start with a lower dose of 0.25 g/kg of mannitol (rather than higher doses) in patients with SDH and hyponatremia, and administer over 30-60 minutes to minimize rapid fluid shifts 1

Monitoring Requirements

• Monitor serum osmolality to ensure it remains below 320 mOsm/L in patients with SDH and hyponatremia receiving mannitol 1
• Assess neurological status continuously in patients with SDH and hyponatremia receiving mannitol 2
• The effect of mannitol on ICP is dose-dependent during the period of ICP reduction in patients with SDH 2