D-mannitol

Mannitol is a type of sugar alcohol which is also used as a medication. As a sugar, it is often used as a sweetener in diabetic food, as it is poorly absorbed from the intestines. As a medication, it is used to decrease pressure in the eyes, as in glaucoma, and to lower increased intracranial pressure. Medically, it is given by injection. Effects typically begin within 15 minutes and last up to 8 hours. Common side effects from medical use include electrolyte problems and dehydration. Other serious side effects may include worsening heart failure and kidney problems. It is unclear if use is safe in pregnancy. Mannitol is in the osmotic diuretic family of medications and works by pulling fluid from the brain and eyes. The discovery of mannitol is attributed to Joseph Louis Proust in 1806. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is about US$1.12 to 5.80 a dose. In the United States, a course of treatment costs $25 to $50. It was originally made from the flowering ash and called manna due to its supposed resemblance to the Biblical food. Mannitol is on the World Anti-Doping Agency's banned drug list due to concerns that it may mask other drugs. Mannitol is used to reduce acutely raised intracranial pressure until more definitive treatment can be applied, e.g., after head trauma. It may also be used for certain cases of kidney failure with low urine output, decreasing pressure in the eye, to increase the elimination of certain toxins, and to treat fluid build up. Intraoperative mannitol prior to vessel clamp release during renal transplant has been shown to reduce post-transplant kidney injury, but has not been shown to reduce graft rejection. Mannitol acts as an osmotic laxative in oral doses larger than 20 g, and is sometimes sold as a laxative for children. The use of mannitol, when inhaled, as a bronchial irritant as an alternative method of diagnosis of exercise-induced asthma has been proposed. A 2013 systematic review concluded evidence to support its use for this purpose at this time is insufficient.