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What Is Mannitol Used For

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Chemic compound

Mannitol
Mannitol structure.png
Mannitol-3D-balls.png
Clinical data
Trade names Osmitrol, Bronchitol, others
Other names d-Mannitol, mannite, manna carbohydrate
AHFS/Drugs.com Monograph
License information
  • EU  EMA:by INN
  • US  DailyMed:Mannitol
Pregnancy
category
  • AU: B2
Routes of
administration		 Intravenous, By rima oris
ATC code
  • A06AD16 (WHO) B05BC01 (WHO) B05CX04 (WHO) R05CB16 (WHO) V04CX04 (WHO)
Legal status
Legal status
  • US: Rx-only for medical use Available over the counter as a food sweetener[ane]
  • European union: Rx-simply [2]
Pharmacokinetic data
Bioavailability ~7%
Metabolism Liver, negligible
Elimination one-half-life 100 minutes
Excretion Kidney: 90%
Identifiers

IUPAC proper noun

  • (2R,3R,4R,vR)-Hexane-1,2,three,4,5,6-hexol
CAS Number
  • 69-65-8 check Y
PubChem CID
  • 6251
DrugBank
  • DB00742 check Y
ChemSpider
  • 6015 check Y
UNII
  • 3OWL53L36A
KEGG
  • D00062 check Y
ChEBI
  • CHEBI:16899 check Y
ChEMBL
  • ChEMBL689 check Y
Due east number E421 (thickeners, ...) Edit this at Wikidata
CompTox Dashboard (EPA)
  • DTXSID1023235 Edit this at Wikidata
ECHA InfoCard 100.000.647 Edit this at Wikidata
Chemical and physical data
Formula C 6 H 14 O 6
Molar mass 182.172 g·mol−1
3D model (JSmol)
  • Interactive prototype

SMILES

  • O[C@H]([C@H](O)CO)[C@H](O)[C@H](O)CO

InChI

  • InChI=1S/C6H14O6/c7-1-iii(9)v(xi)6(12)four(10)2-8/h3-12H,1-2H2/t3-,iv-,5-,6-/m1/s1check Y

  • Primal:FBPFZTCFMRRESA-KVTDHHQDSA-Due northcheck Y

(verify)

Mannitol is a type of sugar alcohol used equally a sweetener and medication.[3] [4] It is used every bit a low calorie sweetener as it is poorly absorbed past the intestines.[3] As a medication, it is used to decrease pressure in the eyes, as in glaucoma, and to lower increased intracranial force per unit area.[5] [4] Medically, it is given by injection.[6] Effects typically brainstorm within 15 minutes and last upwardly to viii hours.[6]

Common side effects from medical use include electrolyte problems and dehydration.[six] Other serious side effects may include worsening heart failure and kidney problems.[6] [iv] Information technology is unclear if use is prophylactic in pregnancy.[half-dozen] Mannitol is in the osmotic diuretic family of medications and works by pulling fluid from the brain and optics.[6]

The discovery of mannitol is attributed to Joseph Louis Proust in 1806.[7] It is on the Globe Health Organization's List of Essential Medicines.[viii] It was originally fabricated from the flowering ash and chosen manna due to its supposed resemblance to the Biblical food.[ix] [10] Mannitol is on the Earth Anti-Doping Agency's banned drug list due to concerns that it may mask other drugs.[11]

Uses [edit]

Mannitol 15% solution for intravenous use

Medical uses [edit]

In the United States, mannitol is indicated for the reduction of intracranial pressure level and treatment of cerebral edema and elevated intraocular pressure level.[1]

In the European union, mannitol is indicated for the treatment of cystic fibrosis (CF) in adults anile eighteen years and to a higher place every bit an add-on therapy to all-time standard of intendance.[2]

Mannitol is used intravenously to reduce acutely raised intracranial pressure until more definitive treatment tin can be applied,[12] e.g., later on caput trauma. Intra-arterial infusions of mannitol can transiently open the blood-encephalon bulwark past disrupting tight junctions.[thirteen] [14]

Information technology may likewise be used for certain cases of kidney failure with low urine output, decreasing pressure in the center, to increment the emptying of certain toxins, and to care for fluid build up.[6]

Intraoperative mannitol prior to vessel clamp release during renal transplant has been shown to reduce mail-transplant kidney injury, but has not been shown to reduce graft rejection.[ medical commendation needed ]

Mannitol acts as an osmotic laxative[i] [15] in oral doses larger than 20 g,[xvi] and is sometimes sold equally a laxative for children.[ citation needed ]

The apply of mannitol, when inhaled, as a bronchial irritant every bit an alternative method of diagnosis of exercise-induced asthma has been proposed. A 2013 systematic review concluded evidence to back up its use for this purpose at this time is insufficient.[17]

Mannitol is commonly used in the excursion prime of a center lung car during cardiopulmonary bypass. The presence of mannitol preserves renal role during the times of low blood menstruum and pressure, while the patient is on featherbed. The solution prevents the swelling of endothelial cells in the kidney, which may have otherwise reduced blood flow to this area and resulted in jail cell damage.

Mannitol can also be used to temporarily encapsulate a sharp object (such every bit a helix on a lead for an bogus pacemaker) while it passes through the venous system. Considering the mannitol dissolves readily in blood, the sharp betoken becomes exposed at its destination.

Mannitol is also the first drug of choice to treat astute glaucoma in veterinarian medicine. It is administered as a 20% solution intravenously. It dehydrates the vitreous humor and, therefore, lowers the intraocular pressure. However, it requires an intact blood-ocular barrier to work.[18]

Food [edit]

Mannitol increases claret glucose to a lesser extent than sucrose (thus having a relatively low glycemic alphabetize[19]) so is used as a sweetener for people with diabetes, and in chewing gums. Although mannitol has a college oestrus of solution than virtually sugar alcohols, its comparatively low solubility reduces the cooling consequence ordinarily plant in mint candies and gums. However, when mannitol is completely dissolved in a product, information technology induces a stiff cooling event.[xx] Besides, it has a very low hygroscopicity – it does not pick up water from the air until the humidity level is 98%. This makes mannitol very useful as a coating for hard candies, dried fruits, and chewing gums, and it is often included every bit an ingredient in candies and chewing gum.[21] The pleasant sense of taste and mouthfeel of mannitol too makes it a popular excipient for chewable tablets.[22]

Analytical chemical science [edit]

Mannitol can be used to class a circuitous with boric acrid. This increases the acrid strength of the boric acrid, permitting better precision in volumetric analysis of this acid.[23]

Other [edit]

Mannitol is the primary ingredient of mannitol table salt agar, a bacterial growth medium, and is used in others.

Mannitol is used every bit a cutting amanuensis[24] in various drugs that are used intranasally (snorted), such every bit cocaine. A mixture of mannitol and fentanyl (or fentanyl analogs) in ratio 1:10 is labeled and sold as "Mainland china white", a popular heroin substitute.[ citation needed ]

Contraindications [edit]

Mannitol is contraindicated in people with anuria, astringent hypovolemia, pre-existing severe pulmonary vascular congestion or pulmonary edema, irritable bowel syndrome (IBS), and active intracranial bleeding except during craniotomy.[one]

Adverse effects include hyponatremia and volume depletion leading to metabolic acidosis.[7]

Chemical science [edit]

Mannitol is an isomer of sorbitol, another sugar alcohol; the 2 differ but in the orientation of the hydroxyl group on carbon 2.[25] While like, the two saccharide alcohols have very different sources in nature, melting points, and uses.

Production [edit]

Mannitol is classified as a saccharide alcohol; that is, it can be derived from a sugar (mannose) by reduction. Other sugar alcohols include xylitol and sorbitol. Mannitol and sorbitol are isomers, the simply deviation being the orientation of the hydroxyl grouping on carbon two.[20]

Industrial synthesis [edit]

Mannitol is usually produced via the hydrogenation of fructose, which is formed from either starch or sucrose (common table saccharide). Although starch is a cheaper source than sucrose, the transformation of starch is much more complicated. Somewhen, it yields a syrup containing about 42% fructose, 52% glucose, and vi% maltose. Sucrose is only hydrolyzed into an capsize sugar syrup, which contains near 50% fructose. In both cases, the syrups are chromatographically purified to contain 90–95% fructose. The fructose is and so hydrogenated over a nickel catalyst into a mixture of isomers sorbitol and mannitol. Yield is typically fifty%:fifty%, although slightly element of group i reaction conditions can slightly increase mannitol yields.[20]

Biosyntheses [edit]

Mannitol is ane of the most abundant energy and carbon storage molecules in nature, produced by a plethora of organisms, including bacteria, yeasts, fungi, algae, lichens, and many plants.[26] Fermentation by microorganisms is an culling to the traditional industrial synthesis. A fructose to mannitol metabolic pathway, known equally the mannitol bike in fungi, has been discovered in a type of ruby-red algae (Caloglossa leprieurii), and it is highly possible that other microorganisms use similar such pathways.[27] A class of lactic acid leaner, labeled heterofermentive considering of their multiple fermentation pathways, convert either three fructose molecules or two fructose and 1 glucose molecule into two mannitol molecules, and ane molecule each of lactic acid, acetic acrid, and carbon dioxide. Feedstock syrups containing medium to large concentrations of fructose (for example, cashew apple juice, containing 55% fructose: 45% glucose) can produce yields 200 g (7.i oz) mannitol per liter of feedstock. Further inquiry is being conducted, studying ways to engineer even more than efficient mannitol pathways in lactic acid bacteria, also every bit the use of other microorganisms such as yeast[26] and E. coli in mannitol production. When nutrient-class strains of any of the aforementioned microorganisms are used, the mannitol and the organism itself are direct applicable to food products, avoiding the need for careful separation of microorganism and mannitol crystals. Although this is a promising method, steps are needed to scale information technology upwardly to industrially needed quantities.[27]

[edit]

Since mannitol is found in a wide diversity of natural products, including nigh all plants, it can be directly extracted from natural products, rather than chemical or biological syntheses. In fact, in China, isolation from seaweed is the nearly common form of mannitol production.[21] Mannitol concentrations of found exudates can range from 20% in seaweeds to 90% in the plane tree. Information technology is a elective of saw palmetto (Serenoa).[28]

Traditionally, mannitol is extracted past the Soxhlet extraction, using ethanol, water, and methanol to steam and then hydrolysis of the crude material. The mannitol is then recrystallized from the excerpt, mostly resulting in yields of about 18% of the original natural product. Some other method of extraction is using supercritical and subcritical fluids. These fluids are at such a stage that no difference exists between the liquid and gas stages, so are more than diffusive than normal fluids. This is considered to make them much more than effective mass transfer agents than normal liquids. The super- or subcritical fluid is pumped through the natural product, and the mostly mannitol product is easily separated from the solvent and infinitesimal amount of byproduct.

Supercritical carbon dioxide extraction of olive leaves has been shown to require less solvent per measure of leaf than a traditional extraction – 141.7 1000 (five.00 oz) CO2 versus 194.4 k (half-dozen.86 oz) ethanol per 1 g (0.035 oz) olive leaf. Heated, pressurized, subcritical h2o is even cheaper, and is shown to have dramatically greater results than traditional extraction. It requires only 4.01 g (0.141 oz) h2o per 1 g (0.035 oz) of olive leaf, and gives a yield of 76.75% mannitol. Both super- and subcritical extractions are cheaper, faster, purer, and more environmentally friendly than the traditional extraction. However, the required high operating temperatures and pressures are causes for hesitancy in the industrial utilize of this technique.[27]

History [edit]

Julije Domac elucidated the construction of hexene and mannitol obtained from Caspian manna. He determined the identify of the double bond in hexene obtained from mannitol and proved that it is a derivative of a normal hexene. This as well solved the construction of mannitol, which was unknown until and then.[29] [thirty] [31] [32]

Controversy [edit]

The three studies[33] [34] [35] that initially found that loftier-dose mannitol was effective in cases of severe caput injury were the subject field of an investigation published in 2007.[36] Although several authors are listed with Dr. Julio Cruz, it is unclear whether the authors had knowledge of how the patients were recruited. Farther, the Federal University of São Paulo, which Cruz gave as his affiliation, has never employed him. Equally a result of dubiousness surrounding Cruz's piece of work, an updated version of the Cochrane review excludes all studies by Julio Cruz, leaving only four studies.[v] Due to differences in selection of control groups, a conclusion about the clinical use of mannitol could not be reached.

Compendial status [edit]

  • British Pharmacopoeia[37]
  • Japanese Pharmacopoeia[38]
  • The states Pharmacopeia[39]

See also [edit]

  • d-mannitol oxidase
  • Due east number
  • Mannitol dehydrogenase
  • Mannitol dehydrogenase (cytochrome)
  • Mannitol-one-phosphatase
  • Mannitol two-dehydrogenase
  • Mannitol ii-dehydrogenase (NADP+)
  • Mannitol-one-phosphate v-dehydrogenase

References [edit]

  1. ^ a b c d "Osmitrol- mannitol injection, solution". DailyMed. fifteen November 2018. Retrieved 28 October 2020.
  2. ^ a b "Bronchitol EPAR". European Medicines Agency (EMA). Retrieved 28 Oct 2020. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  3. ^ a b Varzakas T, Labropoulos A, Anestis Due south (2012). Sweeteners: Nutritional Aspects, Applications, and Production Engineering. CRC Press. pp. 59–lx. ISBN9781439876732. Archived from the original on x September 2017.
  4. ^ a b c Globe Health System (2009). Stuart MC, Kouimtzi Chiliad, Colina SR (eds.). WHO Model Formulary 2008. World Health Organisation. p. 332. hdl:10665/44053. ISBN9789241547659.
  5. ^ a b Wakai A, McCabe A, Roberts I, Schierhout K (August 2013). "Mannitol for acute traumatic brain injury". The Cochrane Database of Systematic Reviews. 8 (eight): CD001049. doi:ten.1002/14651858.CD001049.pub5. PMC7050611. PMID 23918314.
  6. ^ a b c d e f g "Mannitol". The American Society of Health-System Pharmacists. Archived from the original on 26 May 2015. Retrieved 8 January 2015.
  7. ^ a b
  8. ^ Globe Wellness Organization (2019). World Wellness System model list of essential medicines: 21st list 2019. Geneva: World Health Arrangement. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA iii.0 IGO.
  9. ^ Cottrell JE, Patel P (2016). Cottrell and Patel's Neuroanesthesia. Elsevier Wellness Sciences. p. 160. ISBN9780323461122.
  10. ^ Bardal S, Waechter J, Martin D (2010). Applied Pharmacology. Elsevier Health Sciences. p. 411. ISBN978-1437735789.
  11. ^ "THE 2017 PROHIBITED LIST INTERNATIONAL STANDARD" (PDF). Jan 2017. p. five. Retrieved 7 July 2018.
  12. ^ "Mannitol (Intravenous Route)". Mayo Clinic.
  13. ^ Rapoport, Stanley (April 2020). "Osmotic opening of the blood-encephalon bulwark: principles, mechanism, and therapeutic applications". Prison cell Mol Neurobiol. twenty (2): 217–30. doi:ten.1023/a:1007049806660. PMID 10696511. S2CID 20258642.
  14. ^ Linville, Raleigh; DeStefano, Jackson; Sklar, Matt; Chu, Chengyan; Walczak, Piotr; Searson, Peter (July 2020). "Modeling hyperosmotic blood–brain barrier opening within human tissue-engineered in vitro brain microvessels". Journal of Cognitive Blood Flow & Metabolism. 40 (vii): 1517–1532. doi:x.1177/0271678X19867980. PMC7308510. PMID 31394959. S2CID 199507024.
  15. ^ "Select Commission on GRAS Substances (SCOGS) Opinion: Mannitol". FDA.gov. April 2013. Archived from the original on 22 October 2014.
  16. ^ Ellis FW, Krantz JC (1941). "Sugar alcohols: XXII. Metabolism and toxicity studies with mannitol and sorbitol in human and animals". J. Biol. Chem. 141: 147–154. doi:10.1016/S0021-9258(xviii)72829-ix. Archived from the original on x September 2017.
  17. ^ Stickland MK, Rowe BH, Spooner CH, Vandermeer B, Dryden DM (September 2011). "Accuracy of eucapnic hyperpnea or mannitol to diagnose exercise-induced bronchoconstriction: a systematic review". Annals of Allergy, Asthma & Immunology. 107 (three): 229–34.e8. doi:10.1016/j.anai.2011.06.013. PMID 21875541.
  18. ^ Veterinarian Class Notes, Ophthalmology, The Ohio Land Academy, provided by David Wilkie, DVM, DACVO
  19. ^ Grenby TH (2011). Advances in Sweeteners. Springer. p. 66. ISBN978-1461285229.
  20. ^ a b c Kearsley MW, Deis RC (2006). "Sorbitol and Mannitol". Sweeteners and Saccharide Alternatives in Nutrient Technology. Wiley-Blackwell. pp. 249–261. ISBN0470659688.
  21. ^ a b Lawson P (2007). Mannitol. Blackwell Publishing Ltd. pp. 219–225.
  22. ^ Weiner ML, Kotkoskie LA (1999). Excipient Toxicity and Safety . pp. 370. ISBN9780824782108.
  23. ^ Belcher R, Nutten AJ (1960). Quantitative Inorganic Analysis (2nd ed.). London, Britain: Butterworths. p. 194.
  24. ^ "Cut the Shit". Dec 2005. Archived from the original on 27 September 2016. Retrieved four September 2017.
  25. ^ Kearsley MW, Deis RC (2006). "Sorbitol and Mannitol". Sweeteners and Sugar Alternatives in Food Technology. Ames: Oxford. pp. 249–261.
  26. ^ a b Song SH, Vieille C (August 2009). "Recent advances in the biological production of mannitol". Applied Microbiology and Biotechnology. 84 (ane): 55–62. doi:10.1007/s00253-009-2086-five. PMID 19578847. S2CID 42103028.
  27. ^ a b c Ghoreishi SM, Shahrestani RG (2009). "Innovative strategies for engineering mannitol production". Trends in Food Scientific discipline & Applied science. 20 (six–vii): 263–270. doi:10.1016/j.tifs.2009.03.006.
  28. ^ Wagner H, Flachsbarth H, Vogel G (March 1981). "[A New Antiphlogistic Principle from Sabal serrulata, 2]". Planta Medica. 41 (3): 252–8. doi:10.1055/due south-2007-971711. PMID 17401849.
  29. ^ Inić S, Kujundžić Northward (2011). "The beginning independent pharmacognosy plant in the world and its founder Julije Domac (1853–1928)". Die Pharmazie (in German). 66 (6): 720–726.
  30. ^ Domac J (1881). "Über das Hexylen aus Mannit". Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften, Mathematisch-Naturwissenschaftliche Classe (in German language). 23: 1038–1051.
  31. ^ Domac J (1881). "Über das Hexylen aus Mannit". Monatshefte für Chemie (in German). 2: 309–322. doi:10.1007/BF01516516. S2CID 94940823.
  32. ^ Domac J (1882). "II. Ueber die Einwirkung der Unterchlorsäure auf Hexylen". Justus Liebig'southward Annalen der Chemie (in German). 213: 124–132. doi:x.1002/jlac.18822130107.
  33. ^ Cruz J, Minoja G, Okuchi Thou (October 2001). "Improving clinical outcomes from astute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial". Neurosurgery. 49 (iv): 864–71. doi:10.1097/00006123-200110000-00016. PMID 11564247. S2CID 43880412.
  34. ^ Cruz J, Minoja G, Okuchi G (September 2002). "Major clinical and physiological benefits of early on high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial". Neurosurgery. 51 (3): 628–37, discussion 637–8. doi:10.1097/00006123-200209000-00006. PMID 12188940. S2CID 20678448.
  35. ^ Cruz J, Minoja Grand, Okuchi Thou, Facco E (March 2004). "Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Calibration scores of three and bilateral abnormal pupillary widening: a randomized trial". Periodical of Neurosurgery. 100 (iii): 376–83. doi:10.3171/jns.2004.100.three.0376. PMID 15035271.
  36. ^ Roberts I, Smith R, Evans S (Feb 2007). "Doubts over head injury studies". BMJ. 334 (7590): 392–4. doi:10.1136/bmj.39118.480023.Be. PMC1804156. PMID 17322250.
  37. ^ British Pharmacopoeia Commission Secretariat (2009). "Index, BP 2009" (PDF). Archived from the original (PDF) on 11 Apr 2009. Retrieved 31 January 2010.
  38. ^ "Japanese Pharmacopoeia, Fifteenth Edition" (PDF). 2006. Archived from the original (PDF) on 22 July 2011. Retrieved 31 Jan 2010.
  39. ^ USP 32 (2008). "Mannitol Injection" (PDF). Archived from the original (PDF) on six July 2010. Retrieved 31 January 2010.

External links [edit]

  • Media related to Mannitol at Wikimedia Commons
  • "Mannitol". Drug Data Portal. U.S. National Library of Medicine.

What Is Mannitol Used For,

Source: https://en.wikipedia.org/wiki/Mannitol

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