For Elevated Intracranial Pressure: Give 0.25 g/kg IV over 30 minutes; may repeat every 6 to 8 hours, that is what you mean probably. You should know that BNFC mentioned that in cerebral edema dose may be repeated 1–2 times after 4–8 hours. So, the interval of the doses is widely variable according to the patient status.

Regarding osmolality: repeat as needed to maintain serum osmolality <300 to 320 mOsm/kg (BTF [Carney 2016]; Hegenbarth 2008; Kochanek 2012).

Mannitol may increase cerebral blood flow, increase the risk of postoperative bleeding in neurosurgical patients, and worsen intracranial hypertension in children who develop generalized cerebral hyperemia during the first 24 to 48 hours after traumatic brain injury.

Also, hypotension is a documented side effect of mannitol.

You should know that mannitol is contraindicated in anuria; severe hypovolemia; active intracranial bleeding except during craniotomy; preexisting severe pulmonary vascular congestion or pulmonary edema.

Do not administer with blood. Crenation and agglutination of red blood cells may occur if administered with whole blood. Do not administer simultaneously. خلي في بينهم وقت أحسن