The theoretical considerations which lead us to include hypertonic mannitol as part of the blood perfusion mixture in selected patients undergoing open-heart surgery are reviewed. In over 500 total body perfusions, mannitol has proven to be an effective, non-toxic substance which has significantly reduced our incidence of postoperative renal failure. The distribution of mannitol occurs in two phases and appears to be confined to the extracellular fluid space. Equilibration within this space requires more than 3 hours; 83% of the administered mannitol was recovered during the succeeding 24 hours. The plasma disappearance curve cannot be used to measure renal clearance, since the volume of distribution is constantly expanding during the period of observation plus the occurrence of renal tubular reabsorption of approximately 20% of the filtered mannitol. The salures is induced by hypertonic mannitol during cardiopulmonary bypass was restricted to the interval of maximum osmotic diuresis and did not lead to postoperative hyponatremia.
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