Osmotic agents, such as mannitol, are not absorbed by the nephron. Rather, they induce diuresis by raising the osmolarity of the glomerular filtrate, thereby attracting more water in the tubules to increase urine volume. The main effect of osmotic agents is to decrease intravascular volume, but toxicity can result in pulmonary edema, anaphylaxis, and acute renal failure. Overdoses can cause profound volume loss, accompanied by electrolyte imbalances. Treatment is aimed at repleting the intravascular volume and correcting any electrolyte imbalances. Other adverse reactions—such as pulmonary congestion, acidosis, electrolyte loss, dryness of mouth, thirst, marked diuresis, urinary retention, edema, headache, blurred vision, convulsions, nausea, vomiting, rhinitis, skin necrosis, thrombophlebitis, chills, dizziness, urticaria, dehydration, fever and angina-like chest pains—have been reported during or following mannitol infusion.
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