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Case Report
A Case of Oliguric Mannitol Induced Acute Kidney Injury Early Treated by Continuous Renal Replacement Therapy
Kyungo Hwang1, Yeo-Jin Kang1, Eun Jin Bae1, Se-Ho Chang1,2, Dong Jun Park1,2
Kosin Medical Journal 2014;29(1):59-62.
DOI: https://doi.org/10.7180/kmj.2014.29.1.59
Published online: December 17, 2014

Department of Internal Medicine, School of Medicine, Gyeongsang National University, Gyeongnam, Korea

2Institute of Health Science, School of Medicine, Gyeongsang National University, Gyeongnam, Korea

Corresponding Author: Dong Jun Park, Deparment of Internal Medicine, Institute of Health Science, School of Medicine, Gyeongsang National University, Chiram-dong, Jinju-si, Gyeongsangnam-do, Korea TEL: +82-55-750-8739 FAX: +82-55-758-9122 E-mail: drpdj@korea.com
• Received: August 28, 2012   • Revised: November 23, 2012   • Accepted: January 2, 2013

Copyright © 2014 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • We report oliguric mannitol-induced acute kidney injury (AKI) early treated by continuous renal replacement therapy. A 70-year-old woman was admitted to the Department of Neurology with diagnosis of acute intracranial hemorrhage. Mannitol was infused for intracranial pressure control. At admission third day, urine output was abruptly decreased to 57 ml during first 6 hours and blood urea nitrogen (BUN) and serum creatinine was increased to 54.2 mg/dL and 5.3 mg/dL respectively. Plasma osmolality was 340 mOsm/kg and osmolar gap was 70. Mannitol was immediately withdrawn and continuous renal replacement therapy (CRRT) was performed to remove mannitol rapidly. Urine output was increased 6 hours later after continuous veno-veno hemodiafiltration (CVVHDF) start. BUN and creatinine was decreased to 21.4 and 1.2 mg/dL at admission ninth day. Mannitol can develop oliguric AKI and CRRT may be of more benefit than conventional hemodialysis in the case of increased intracranial pressure.
Fig. 1.
Brain CT shows hemorrhage in thalamus extending into ventricle.
kmj-29-59f1.jpg
Table 1.
Changes of serum laboratory findings during admission
  Adm day 3rd day 4th day 5th day 9th day
BUN (mg/dL) 28.4 54.2 40.8 38.7 21.4
Cr (mg/dL) 1.31 5.23 3.52 2.6 1.2
Serum glucose (mg/dL) 257 181 225 280 201
Serum Osm (mosm/kg) NA 348 318 323 304
Serum sodium (mEq/L) 137 118.5 132 133 133
Serum potassium (mEq/L) NA 5.4 3.8 3.9 3.6
Serum chloride (mEq/L) NA 90.9 98 97.8 98.8
Urine Osm (mosm/kg) NA 357 354 NA 465
Urine sodium (mEq/L) NA <10 69.9 NA 55
Urine potassium (mEq/L) NA 22.5 16.1 NA 8.9
Urine chloride (mEq/L) NA 17.2 78.1 NA 57.6

BUN; Blood urea nitrogen, Cr; Creatinine, Adm; Admission, Osm; Osmolality,

3rd day after admission, NA; non-applicable.

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