Profile of children with increased intracranial pressure on mannitol treatment
Keywords:
increased intracranial pressure, mannitol, indicators
Abstract
Background Early recognition of increased intracranial pressure(IIP) and well-monitored management are determining indicators
for treatment outcome. As far as we know, data of children with IIP
on mannitol treatment has not been available.
Objective To elicit the profile of IIP patients who received mannitol
at the Department of Child Health, Cipto Mangunkusumo Hospital,
Jakarta.
Methods This was a cross-sectional study. Data were obtained
from medical records of patients with increased intracranial pres-
sure who received mannitol at the Department of Child Health,
Cipto Mangunkusumo Hospital, Jakarta between July 2001 to Oc-
tober 2003
Results Fifty-four IIP patients with mannitol treatment were included.
Forty-two (78%) were under-five years old. Thirty-six subjects (67%)
were boys; 30 (56%) were undernourished. Central nervous system
infections (meningitis and encephalitis) were the most frequent causes
of IIP. Most of the head CT scan revealed cerebral edema, hydroceph-
alus, and cerebral hemorrhage. Fifty subjects (93%) had decline of con-
sciousness; most of them were somnolent. Improvement in conscious-
ness was identified in 31 subjects, in which 21 subjects reached full
consciousness. Vomiting, which was found in 25 subjects (46%), sub-
sided after mannitol administration. Behavioral changes were found in
49 subjects (91%); 32 subjects still had persistent behavioral changes
after mannitol administration. Large and protruding fontanel was found
in 7/22 subjects, cerebral nerve paralysis in 23 subjects (43%) and
papillary edema in 6 of 34 subjects who underwent funduscopy. During
the treatment with mannitol, fever was found in 5 subjects, vomiting in 2
subjects, skin edema and tachycardia each in 1 subject. Metabolic aci-
dosis was found in 6/13 subjects, hyponatremia and hypokalemia in 16
and 13 out of 30 subjects respectively. Death occurred in 9 subjects
(17%).
Conclusion In IIP patients, the administration of mannitol has a
tendency to improve consciousness, vomiting, and behavioral or
personality changes. The high incidence rate of electrolyte imbal-
ances and metabolic acidosis during the treatment indicated the
need of periodic monitoring to detect early disorders.
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Soetomenggolo TS, Ismael S, editors. Buku Ajar
Neurologi Anak. Jakarta: BP IDAI; 1999. p. 60-77.
2. Miller JD. Basic intracranial dynamics. In: Minns RA,
editor. Problem of intracranial pressure in childhood.
1 st ed. London: Mac Keith Press; 1991. p. 1-12.
3. Larsen GY, Goldstein B. Increased intracranial pres-
sure. Pediatr Rev 1999;20:234-9.
4. Miller RD. Anesthesia. 5 th edition. New York: Churchill
Livingstone; 2000. p. 2467-72.
5. Allen CH, Ward JD. An evidence-based approach to
management of increased intracranial pressure. Crit
Care Clin 1998;14:485-95.
6. Jackson EK. Diuretics. In: Wonsiewicz MJ, McCurdy P,
editors. Goodman & Gilman’s, the pharmacological ba-
sis of therapeutics. 9 th ed. New York: McGraw-Hill; 1996.
p. 685-714.
7. Cohen DS, Quest DO. Increased intracranial pressure,
brain herniation, and their control. In: Wilkins RH,
Rengachary SS, editors. Neurosurgery. 2 nd ed. New York:
McGraw-Hill; 1996. p.345-56.
8. Morriss FC, Cook JD. Increased intracranial pressure.
In: Levin DL, Morriss FC, Moore GC, editors. A prac-
tical guide to pediatric intensive care. 2 nd ed. St. Louis:
Mosby Company; 1984. p. 47-53.
9. Kimelberg HK. Current concepts of brain edema. J
Neurosurg 1995;83:1051-9.
10. Pollay M. Blood brain barrier; cerebral edema. In: Wilkins
RH, Rengachary SS, editors. Neurosurgery. 2 nd ed. New
York: McGraw-Hill; 1996. p. 335-44.
11. Dollery SR. Therapeutic drugs. Edinburg: Churchill
Livingstone; 1991. p. M5-8.
12. Chasse R. Diuretic, erytropoietin, and other medica-
tions used in renal failure. In: Chernow B, editor. Es-
sential of critical care pharmacology. 2 nd ed. Baltimore:
William & Wilkins; 1994. p. 432-9.
13. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli
TA. Continuous monitoring of cerebral oxygen-
ation in acute brain injury: injection of mannitol
during hyperventilation. J Neurosurg
1990;73:725-30.
14. Mardjono M, Sidharta P. Neurologi klinis dasar. 8 th ed.
Jakarta: PT Dian Rakyat; 2000. p. 390-402.
15. Bruce DA. Neurosurgical emergencies. In: Fleisher GR,
Ludwig S, Silverman BK, editors. Synopsis of pediatric
emergency medicine. 1 st ed. Baltimore: Williams &
Wilkins; 1996. p. 764-8.
16. Friedman DI. Papilledema and pseudotumor cerebri.
Ophthal Clin of North Am 2001;14:116-30.
17. Paczynski RP. Osmotherapy, basic concepts and con-
troversies. Crit Care Clin 1997;13:105-29.
Published
2016-10-10
How to Cite
1.
Teddy S, Latief A, Madiyono B. Profile of children with increased intracranial pressure on mannitol treatment. PI [Internet]. 10Oct.2016 [cited 22Nov.2024];44(4):148-2. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/754
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Received 2016-09-30
Accepted 2016-09-30
Published 2016-10-10
Accepted 2016-09-30
Published 2016-10-10
