Abstract
A case of acute renal failure associated with mannitol infusion is reported. A 49-year-old man with a past history of hypertension whose serum creatinine level was 1.93mg/dl, underwent graft replacement for dissecting aortic aneurysm (DeBakey I). He was not oliguric urine volume: (60-70ml/h) immediately after the operation, but urine volume gradually decreased to about 20ml/h by 12 hours. At that time, blood chemistry findings were: urea nitrogen 35.3mg/dl, creatinine 3.67mg/dl and sodium 125.6mEq/l. Diuresis was not induced by increasing doses of the diuretics given during and after the operation (furosemide, mannitol and bumetanide). Azotemia progressed and pulmonary edema developed, and hemodialysis (HD) was performed on postoperative day 2. Urine volume rapidly increased soon after HD, and there was improvement of renal function. HD was no longer required. The close temporal relationship between mannitol infusion and acute deterioration of renal function in the absence of other recognizable causes, such as shock or graft failure, and the reversal of renal function following a single HD session implies that mannitol was the proximate cause of the acute renal failure in this patient. This case suggests that mannitol should be carefully administered during and after operations, especially in patients with renal impairment.
