Intravenous glycerol and mannitol therapy in children with intracranial hypertension

Introduction:
This text presents a study comparing the safety and efficacy of intravenous glycerol and mannitol therapy in children with severe intracranial hypertension (ICh). The study includes patients with various underlying conditions that caused ICh and involved continuous intracranial pressure monitoring, intensive supportive care, and administration of osmotic agents.

Key Points:

* The study involved 14 patients with ICh admitted over 18 months, with various underlying conditions causing ICh.
* Intravenous glycerol and mannitol were administered to manage ICh, and their safety and efficacy were compared.
* Glycerol and mannitol were equally effective in lowering ICP, with a mean duration of effect of 4.7 hours and 4.4 hours, respectively.
* Two patients failed treatment due to bilateral uncal herniation, and one patient experienced severe rebound pressure elevations following prolonged glycerol administration.
* Glycerol was administered intravenously on 152 occasions, and adverse hematologic effects were seen only twice.
* The failure of other osmotic agents and the need for both increasing doses and frequent administration resulted in severe rebound ICh in one patient.
* Glycerol may promote cerebral lipogenesis through esterification of free fatty acids, improving mitochondrial oxidative phosphorylation.

Main Message:
The study suggests that intravenous glycerol and mannitol are equally effective in managing ICh in children. however, glycerol may offer additional benefits, such as promoting cerebral lipogenesis and improving mitochondrial oxidative phosphorylation. The text emphasizes that intensive supportive care and close monitoring are essential for managing ICh in children, regardless of the osmotic agent used.

MacDonald, John T., and Donald L. Uden. “Intravenous Glycerol and Mannitol Therapy in Children with Intracranial hypertension.” Neurology 32, no. 4 (april 1982): 437–437. https://doi.org/10.1212/WNL.32.4.437.