Hyperkalemic cardiac arrest induced by mannitol administration during craniotomy: A case report and review of the literature

IntroductionMannitol is the most widely used hyperosmolar agent during neurosurgical procedures. However, its use can lead to serious hyperkalemia with altered cardiac conduction. Case presentationHere we report a case in which a 40-min cardiac arrest was caused by mannitol-induced hyperkalemia during craniotomy. In addition, we conducted a literature review through a PubMed (MEDLINE) search of the relevant literature published so far. Details of all cases are presented and discussed. The results suggest that male patients or patients with uncontrolled diabetes might be at higher risk to develop this phenomenon. The results also suggest that the high dose and rapid rate of infusion of mannitol might contribute to mannitol-induced hyperkalemia. ConclusionPhysicians should be aware of the existence of mannitol-induced hyperkalemia. Although the mechanism of this complication is not well established, it is prudent to administer mannitol cautiously, especially in patients with uncontrolled diabetes. Continuous electrocardiogram monitoring and frequent measurements of serum electrolytes can help to detect and treat possible life-threatening events induced by mannitol-induced hyperkalemia early.

Automated summary

This case report highlights the potential risk of mannitol-induced hyperkalemia during neurosurgical procedures. The study suggests that male patients or patients with uncontrolled diabetes might be more susceptible to this phenomenon. It also indicates that the high dose and rapid infusion rate of mannitol could contribute to mannitol-induced hyperkalemia. Therefore, caution should be exercised when administering mannitol, especially in patients with uncontrolled diabetes, and continuous monitoring and measurement are necessary for early detection and treatment of potential life-threatening events induced by mannitol-induced hyperkalemia.