Mannitol Usage Pattern in Hemorrhagic Stroke Patients


Hemorrhagic stroke is a condition where one of the arteries in the brain bursts, causing bleeding in that organ. Mannitol is an osmotic diuretic drug often used to correct high intracranial pressure due to bleeding. This research aimed to determine the pattern of mannitol in hemorrhagic stroke at the Inpatient Installation of Dr. Iskak Tulungagung Regional Public Hospital. This was a retrospective observational study with the presentation of data descriptively in patients with hemorrhagic stroke who received mannitol therapy at Inpatient Installation Dr. Iskak Tulungagung Regional Public Hospital. Mannitol was only used alone with the highest dose (2x0.3g/kgBW) for 65 patients (81%). Mannitol was used in single usage with the highest dose (2x0,3g/kg BW) in 65 patients (81%). Mannitol with the most widely dose switching pattern usage is from (6x0,3g/kg BW) iv to (5x0,3g/kg BW) iv to (4x0.3g/kg BW) iv to (3x0.3g/kg BW) iv to (2x0.3g/kg BW) iv to (1x0.3g/kg BW) iv to 11 patients (14%). Mannitol was given by tapering off or decreasing the dose slowly and the duration of use of Mannitol with the highest percentage at 4-7 days in as many as 68 patients (85%).

Keywords: mannitol, hemorrhagic stroke, diuretic osmotic

[1] Ministry of Health Indonesia. Basic Health Research Results Report. Riskesdas; 2018.

[2] Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May;71(19):e127–248.

[3] DiPiro JT, editor. Pharmacotherapy: a pathophysiologic approach. 10th ed. New York: McGraw-Hill Education; 2017.

[4] Wintermark M, Rizvi T. Principles of Clinical Diagnosis of Hemorrhagic Stroke. In: Stroke Revisited: Hemorrhagic Stroke [Internet]. Singapore: Springer Singapore; 2018 [cited 2022 Oct 31]. p. 109–32. (Stroke Revisited). Available from: 1007/978-981-10-1427-7_9.

[5] IG A, Panggabean R. Management of High Intracranial Pressure in Stroke. Cdk-238. 43(3):180–4.

[6] Katzung BG, editor. Basic & clinical pharmacology. Fourteenth edition. New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto: McGraw-Hill Education; 2018. 1250 p. (A Lange medical book).

[7] Witherspoon B, Ashby NE. The Use of Mannitol and Hypertonic Saline Therapies in Patients with Elevated Intracranial Pressure: A Review of the Evidence. Nurs Clin North Am. 2017 Jun;52(2):249–60.

[8] Amri I. PENGELOLAAN PENINGKATAN TEKANAN INTRAKRANIAL. Med Tadulako J Ilm Kedokt Fak Kedokt Dan Ilmu Kesehat. 2017 Dec;4(3):1–17.

[9] Beale AL, Meyer P, Marwick TH, Lam CS, Kaye DM. Sex Differences in Cardiovascular Pathophysiology: Why Women Are Overrepresented in Heart Failure With Preserved Ejection Fraction. Circulation. 2018 Jul;138(2):198–205.

[10] PERDOSSI (Indonesian Association of Neurologists). Guideline Stroke 2011. PERDOSSI; 2011.

[11] Departemen Anestesiologi dan Terapi Intensif Rumah Sakit Mitra Keluarga Sidoarjo, Christanto S, Umar N, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Sumatera Utara–RSUP H. Adam Malik Medan, Wargahadibrata AH, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran–RSUP Dr. Hasan Sadikin Bandung. Penatalaksanaan Perioperatif Perdarahan Intraserebral. J Neuroanestesi Indones. 2014;4(2):112–20.

[12] Husna U, Dalhar M. PATHOPHYSIOLOGY AND MANAGEMENT OF CEREBRAL EDEMA. MNJ Malang Neurol J. 2017 Jul;3(2):94–107.

[13] Fortunato N. Pathophysiology: The Biologic Basis for Disease in Adults and Children. AORN J. 1996 Jan;63(1):294.

[14] Bereczki D, Liu M, Fernandes do Prado G, Fekete I. Mannitol for Acute Stroke. Stroke. 2008 Feb;39(2):512–3.

[15] Anestesiologi D, Terapi IR, Selatan J, Sidhapramudita MR, Umar N. Departemen Anestesiologi & Terapi Intensif Fakultas Kedokteran Universitas Sumatera Utara– RSUP H. Adam Malik Medan, Rasman M, Departemen Anestesiologi &Terapi Intensif–Fakultas Kedokteran Universitas Padjadjaran– RSUP Dr. Hasan Sadikin Bandung. Total Intravenous Anesthesia pada Geriatri dengan Meningioma Parietalis. J Neuroanestesi Indones. 2015;4(2):112–8.