Mannitol

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Mannitol

Mannitol is an organic compound

Organic compound

An organic compound is any member of a large class of chemical compounds whose molecules contain carbon. For historical reasons discussed below, a few types of compounds such as carbonates, simple oxides of carbon and cyanides, as well as the allotropes of carbon, are considered Inorganic compound....
with the formula (C₆H₈(OH)₆). This polyol

Polyol

The name polyols refers to alcohols containing multiple hydroxyl groups. In two technological disciplines polyols have special meaning: food science and polymer chemistry....
is used as an osmotic

Osmosis

Diuretic

A diuretic is any drug that elevates the rate of urination and thus provides a means of forced diuresis. There are several categories of diuretics....
agent and a weak renal

Kidney

The kidneys are Organ that have numerous biological roles. Their primary role is to maintain the homeostasis balance of bodily fluids by filtering and secreting Metabolomics#Metabolitess and minerals from the blood and excreting them, along with water , as urine....
vasodilator. It was originally isolated from the secretions of the flowering ash, called manna

Manna

Manna , sometimes or archaically spelt mana, is the name of a food which, according to the Bible, was eaten by the Israelites during their travels in the desert....
after their resemblance to the Biblical food, and is also be referred to as mannite and manna sugar.

itol is a sugar alcohol

Sugar alcohol

A sugar alcohol is a hydrogenation form of carbohydrate, whose carbonyl group has been reduced to a primary or secondary hydroxyl group . Sugar alcohols have the general formula Hn+1H, whereas sugars have HnHCO....
, that is, it is derived from a sugar by reduction.

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Chemistry

Mannitol is a sugar alcohol

Sugar alcohol

Xylitol

Xylitol is an organic compound with the formula 32. This achiral species is one of four isomers of 1,2,3,4,5-pentapentanol....
and sorbitol

Sorbitol

Sorbitol, also known as glucitol, is a sugar alcohol that the body metabolises slowly. It is obtained by Redox of glucose changing the aldehyde group to an additional hydroxyl group....
. Aqueous solutions of mannitol are mildly acid

Acid

An acid is traditionally considered any chemical compound that, when dissolved in water, gives a solution with a hydrogen ion Activity greater than in pure water, i.e....
ic and sometimes such solutions are treated to raise the pH

pH is a measure of the Acid or Base of a solution. It is defined as the cologarithm of the Activity of dissolved hydrogen ions . Hydrogen ion activity coefficients cannot be measured experimentally, so they are based on theoretical calculations....
. Chemical Abstracts Registry Numbers for mannitol are 123897-58-5, 69-65-8 (D-Mannitol), 75398-80-0, 85085-15-0, and 87-78-5 (mannitol with unspecified stereochemistry).

Uses

Medical applications

Mannitol is used clinically to reduce acutely raised intracranial pressure

Intracranial pressure

Intracranial pressure, , is the pressure in the cranium and thus in the brain tissue and cerebrospinal fluid ; this pressure is exerted on the brain's intracranial blood circulation vessels....
until more definitive treatment can be applied, e.g. after head trauma

Traumatic brain injury

Traumatic brain injury occurs when an outside force physical trauma the brain. TBI can be classified based on severity, mechanism , or other features ....
. This use is controversial. It is also used to treat patients with oliguric renal failure. It is administered intravenously, and is filtered by the glomeruli

Glomerulus

A glomerulus is a capillary tuft surrounded by Bowman's capsule in nephrons of the vertebrate kidney. It receives its blood supply from an afferent arteriole of the renal circulation....
of the kidney

Kidney

The kidneys are Organ that have numerous biological roles. Their primary role is to maintain the homeostasis balance of bodily fluids by filtering and secreting Metabolomics#Metabolitess and minerals from the blood and excreting them, along with water , as urine....
, but is incapable of being resorbed from the renal tubule, resulting in decreased water and Na

Sodium

Sodium is an element which has the symbol Na , atomic number 11, atomic mass 23 amu , and a common oxidation number +1. Sodium is a soft, silvery white, highly reactive element and is a member of the alkali metals within "group 1" ....
⁺ reabsorption via its osmotic

Osmosis

Osmosis is the diffusion of a solvent through a Semipermeable membrane, from a solution of low solute concentration to a solution with high solute concentration , up a solute concentration gradient....
effect. Consequently, mannitol increases water and Na⁺ excretion, thereby decreasing extracellular fluid volume.

Mannitol can also be used to open the blood-brain barrier

Blood-brain barrier

The blood-brain barrier is a metabolic or cellular structure in the central nervous system that restricts the passage of various chemical substances and microscopic objects between the bloodstream and the neural tissue itself, while still allowing the passage of substances essential to metabolism function ....
by temporarily shrinking the tightly coupled endothelial cells that make up the barrier. This makes mannitol indispensable for delivering various drugs directly to the brain

Brain

The brain is the center of the nervous system in all vertebrate, and most invertebrate, animals. Some primitive animals such as cnidarian and echinoderm have a decentralized nervous system without a brain, while sponges lack any nervous system at all....
(e.g. in the treatment of Alzheimer's disease

Alzheimer's disease

Alzheimer's disease , also called Alzheimer disease, Senile Dementia of the Alzheimer Type or simply Alzheimer's, is the most common form of dementia....
). Mannitol is commonly used in the circuit prime of a heart lung machine during cardiopulmonary bypass. The presence of mannitol preserves renal function during the times of low blood flow and pressure, while the patient is on bypass. The solution prevents the swelling of endothelial cells in the kidney, which may have otherwise reduced blood flow to this area and resulted in cell damage.

Mannitol is also being developed by Australian pharmaceutical company as a treatment for cystic fibrosis

Cystic fibrosis

Cystic Fibrosis is a Genetic disorder affecting the exocrine glands of the lungs, liver, pancreas, and intestines, causing progressive disability due to multisystem failure....
and bronchiectasis

Bronchiectasis

Bronchiectasis is a disease that causes localized, irreversible dilation of part of the bronchial tree. It is classified as an obstructive lung disease, along with bronchitis and cystic fibrosis....
and as a diagnostic test for airway hyperresponsiveness. The mannitol is orally inhaled as a dry powder through what is known as an osmohaler and osmotically draws water into the lungs to thin the thick, sticky mucus characteristic of cystic fibrosis. This is intended to make it easier for the sufferer to cough the mucus up during physiotherapy. The critical characteristic of the mannitol is its particle size distribution

Particle size distribution

The particle size distribution of a powder, or granular material, or particles dispersed in fluid, is a list of values or a mathematical function that defines the relative amounts of particles present, sorted according to size....
.

Mannitol is also the first drug of choice for the treatment of acute glaucoma

Glaucoma

Glaucoma is a group of diseases of the optic nerve involving loss of ganglion cell in a characteristic pattern of optic atrophy. Raised intraocular pressure is a significant risk factor for developing glaucoma ....
in veterinary medicine. It is administered as a 20% solution IV. It dehydrates the vitreous humor and thus lower the intraocular pressure. However, it requires an intact blood-ocular barrier to work.

Mannitol can also be used to temporarily encapsulate a sharp object (such as a helix on a lead for an artificial pacemaker

Artificial pacemaker

A pacemaker is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart....
) while it is passed through the venous system. Because the mannitol dissolves readily in blood, the sharp point will become exposed at its destination.

Mannitol may be administered in cases of severe Ciguatera

Ciguatera

Ciguatera is a foodborne illness poisoning in humans caused by eating marine species whose flesh is contaminated with a toxin known as ciguatoxin, which is present in many microorganisms living in tropical waters....
poisoning. Severe ciguatoxin

Ciguatoxin

Ciguatoxin is a fish poison which causes ciguatera.There are several types: - Ciguatoxin 1 - Ciguatoxin 2 - Ciguatoxin 3 - Ciguatoxin 4B...
, or "tropical fish poisoning" can produce stroke-like symptoms.

Mannitol is the primary ingredient of Mannitol Salt Agar

Mannitol Salt Agar

Mannitol salt agar or MSA is a commonly used growth medium in microbiology. It contains a high concentration of salt , making it selective for Micrococcaceae and Staphylococcus since this level of NaCl is inhibitory to most other bacteria....
, a bacterial growth medium, and is used in others.

In oral doses larger than 20 g, mannitol acts as an osmotic laxative

Laxative

Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the Colon for rectum and bowel examinations, and may be supplemented by enemas in that circumstance....
, and is sometimes sold as a laxative for children.

In foods

Mannitol is also used as a sweetener

Sweetener

A sweetener is a food additive which adds the basic taste of sweetness to a food; artificial sweeteners are sugar substitutes....
for people with diabetes. Since mannitol has a positive heat of solution, it is used as a sweetener in "breath-freshening" candies, the cooling effect contributing to the fresh feel. The pleasant taste and mouthfeel of mannitol also makes it a popular excipient

Excipient

An excipient is an inactive substance used as a carrier for the active ingredients of a medication. In many cases, an "active" substance may not be easily administered and absorbed by the human body; in such cases the substance in question may be dissolved into or mixed with an excipient....
for chewable tablets.

In illicit drugs

Mannitol is sometimes used as an adulterant

Adulterant

Adulterants are chemical substances which should not be contained within other substances for legal or other reasons. Adulterants may be intentionally added to substances to reduce manufacturing costs, or for some deceptive or malicious purpose....
or cutting agent

Cutting agent

A cutting agent is a chemical used to "cut" illicit drugs with something less expensive than the drug itself....
for heroin

Heroin

Heroin is a opioid synthesized from morphine, a derivative of the opium poppy. It is the 3,6-acetate ester of morphine . The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride, however heroin Freebase may also appear as a white powder....
, methamphetamine

Methamphetamine

is a stimulant and sympathomimetics psychoactive drug. It is a member of the family of phenylethylamines. The levorotary levomethamphetamine is an over-the-counter drug and used in Vicks Inhalers for nasal decongestion and does not possess the Central nervous system activity of dextro or racemic methamphetamine....
s or other illicit drugs. In popular culture, when it is used in this manner, it is often referred to as baby laxative..

Controversy

The three studies which initially found that high-dose mannitol was effective in cases of severe head injury have been the subject of a recent investigation. Although several authors are listed with Dr. Julio Cruz, it is unclear whether the authors had knowledge of how the patients were recruited. Further, the Federal University of São Paulo, which Dr. Cruz gave as his affiliation, has never employed him. Currently, therefore, the Cochrane review

Cochrane Collaboration

The Cochrane Collaboration is a group of over 15,000 volunteers in more than 90 countries who apply a rigorous, systematic process to review the effects of health care interventions tested in biomedical randomized controlled trials....
recommending high-dose mannitol has been withdrawn pending re-evaluation, as there is some evidence that mannitol may worsen cerebral edema

Cerebral edema

Cerebral edema is an excess accumulation of water in the intracellular and/or extracellular spaces of the brain....
.

Mannitol

Chemistry

Uses

Medical applications

In foods

In illicit drugs

Controversy

See also

External links