Bedside Snapshot
- Use It For
- Signs of herniation or an ICP crisis; cerebral edema (TBI, stroke, ICH, acute liver failure, pediatric DKA); acutely raised intraocular pressure
- Adult Dose
- Herniation/ICP crisis: 0.5–1 g/kg IV over 15–30 min (5–15 min if herniating), max 0.1 g/kg/min; every 4–6 hr if needed
- Labeled ICP: 0.25 g/kg IV over ≥30 min every 6–8 hr
- Raised IOP: 1.5–2 g/kg IV over ≥30 min, once
- Pediatric Dose
- Herniation or DKA cerebral edema: 0.5–1 g/kg IV over 10–15 min; may repeat after 30 min if needed per ISPAD 2022. Label covers children but defines no pediatric dose (general guide 0.25 g/kg for ICP)
- Onset / Duration
- IV (ICP): 15–30 min / 1.5–6 hr; IV (IOP): peak fall at 30–60 min
- Do Not Give / Hold If
- Anuria; severe hypovolemia; pulmonary edema; active intracranial bleeding outside craniotomy (label); hypersensitivity. Hold for hypotension or hypovolemia (not low CPP from high ICP), low urine output or high gap
- Watch For
- Hypotension from diuresis (BP, CPP); AKI (urine output, creatinine, osmolar gap); Na⁺ and K⁺ swings (electrolytes); overload in renal or heart failure (crackles, SpO₂)
- Reversal / Rescue
- No antidote: stop the infusion; replace urine losses with isotonic fluid; correct Na⁺ and K⁺; hemodialysis removes mannitol in AKI or overload
- Must Remember
- Always use an in-line filter and check for crystals: 20% and 25% solutions crystallize when cold. Replace urine output so the diuresis does not drop BP and CPP
Indications
Emergency & Prehospital
- Clinical signs of transtentorial herniation: the level of consciousness falls, and a new dilated pupil or posturing shows up. This is a Tier 1 osmotic rescue in the Emergency Neurological Life Support (ENLS) protocol, given while definitive care is arranged (critical-care transport and ED). At the scene for TBI? Not recommended (see Field & Transport)
ED / ICU / Transport
- Raised intracranial pressure (ICP) and cerebral edema: this is the labeled indication. Treat it when ICP stays >22 mmHg (>20 mmHg in children) or when clinical signs appear.
- Traumatic brain injury (TBI): Neurocritical Care Society (NCS) 2020 suggests hypertonic saline 3% first. Mannitol is the effective alternative when hypertonic saline can't be given (conditional, low-quality evidence). Neither one improves neurologic outcome. The Brain Trauma Foundation 4th edition (2017) keeps the Third Edition mannitol advice: 0.25–1 g/kg, avoid SBP <90 mmHg, and use before ICP monitoring only for herniation or progressive deterioration. That advice is labeled as not supported by evidence that meets current standards
- Acute ischemic stroke with malignant edema: mannitol or hypertonic saline. NCS 2020 suggests hypertonic saline when the mannitol response is inadequate, and suggests against scheduled prophylactic mannitol. The 2026 AHA/ASA acute ischemic stroke guideline calls osmotic therapy reasonable as a bridge to surgery in large cerebral or cerebellar infarction with neurologic decline (Class 2a, LOE C-LD). It also recommends early transfer to a neurosurgical or critical-care center (Class 1, LOE C-LD)
- Intracerebral hemorrhage (ICH): NCS 2020 suggests hypertonic saline over mannitol (conditional, very low-quality evidence). Mannitol is still an option
- Cerebral edema in acute liver failure or hepatic encephalopathy: NCS 2020 suggests either one
- Cerebral edema in pediatric diabetic ketoacidosis (DKA): when neurologic status deteriorates acutely, ISPAD 2022 calls for mannitol or hypertonic saline right away
- Neurosurgery: brain relaxation during craniotomy
Other Uses
- Raised intraocular pressure (IOP): use it for acute angle-closure glaucoma when other measures fail, and before eye surgery (labeled)
- Oliguric renal failure, forced diuresis of toxins: the current FDA labels dropped it in 2018–2020. Specialist protocol only
Dosing & Administration
ENLS 2024 sets the herniation and ICP crisis doses (reference 4). The Osmitrol label sets the labeled ICP and IOP doses (reference 1). ISPAD 2022 sets the pediatric DKA cerebral edema dose (reference 7).
Available Forms
- 20% (0.2 g/mL): 250 mL (50 g) and 500 mL (100 g) flexible bags. This is the one most ED, ICU and transport teams use for ICP
- 25% (0.25 g/mL): 12.5 g in 50 mL single-dose vial
- 10% (0.1 g/mL): 500 mL (50 g) bag
- Osmolarity: 20% is 1,098 mOsm/L; 25% is 1,372 mOsm/L (normal plasma osmolality about 275–295 mOsm/kg)
- Volume math: 1 g/kg of 20% = 5 mL/kg (70 kg: 70 g = 350 mL)
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Herniation or ICP crisis | 0.5–1 g/kg IV bolus over 15–30 min (5–15 min for active herniation), never faster than 0.1 g/kg/min (20%: 2.5–5 mL/kg) | Every 4–6 hr if needed, guided by the osmolar gap; no fixed max: hold for hypotension, falling urine output or a high gap | ENLS 2024 Tier 1 dose; peripheral IV acceptable for a bolus. Never exceed 0.1 g/kg/min (0.5 g/kg takes at least 5 min, 1 g/kg at least 10 min); hypotension has been reported at about this rate, so 15–30 min is preferred. Keep the shorter ENLS times for active herniation, with BP watched closely |
| Raised ICP or cerebral edema (labeled) | 0.25 g/kg IV over ≥30 min | Every 6–8 hr; no labeled max (Kim 2023, reference 6, advises avoiding >200 g/day) | Label: this dose usually achieves maximal ICP reduction. Give as boluses, not a continuous infusion |
| Raised IOP (labeled) | 1.5–2 g/kg IV over ≥30 min (20%: 7.5–10 mL/kg) | Single dose; before surgery give 60–90 min ahead | Ophthalmology-directed; with topical and definitive therapy |
Dosing weight: the labels dose per kg and never say which weight. In obesity, follow the institutional protocol (see Special Populations).
Pediatric Dosing
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Herniation, ICP crisis or DKA cerebral edema | 0.5–1 g/kg IV over 10–15 min | ISPAD 2022: may repeat after 30 min if needed; effect expected within ~15 min, lasting ~2 hr. No fixed max: osmolar gap and urine output guide repeats | ISPAD 2022: hypertonic saline 3% 2.5–5 mL/kg over 10–15 min as an alternative, or added if there is no response to mannitol within 15–30 min. In high-risk DKA, have the dose calculated at the bedside |
| Raised ICP (label general guide) | 0.25 g/kg IV over ≥30 min | Every 6–8 hr; the label covers children but defines no pediatric dose | 2019 pediatric severe TBI guidelines recommend 3% saline boluses and make no mannitol recommendation |
| Raised IOP (label general guide) | 1.5–2 g/kg IV over ≥30 min | Single dose | Indication covers children; no pediatric dose defined (label) |
| Neonates and infants <2 yr | No separate dose defined; use the rows above with extra caution | Per neonatal or PICU protocol; reassess before every repeat | Higher risk of fluid and electrolyte derangement (low GFR, limited urine concentration). Do not delay a herniation or DKA cerebral-edema rescue dose; involve PICU or neonatology early |
See weight-based dosing.
Preparation & Administration
- Filter: every set gets a final in-line filter, because microscopic crystals can form in 20% and 25% solutions
- Crystals: inspect before use. Bags: warm up to 70°C (158°F) with agitation, never in a water bath or microwave. 25% vials: warm in water at 80°C (176°F) and shake. Cool to body temperature, re-inspect, discard if crystals persist
- Rate: never faster than 0.1 g/kg/min (0.5 g/kg over at least 5 min, 1 g/kg over at least 10 min). Slow is better: prefer 15–30 min, because a fast bolus drops the pressure. The ENLS 5–15 min is for active herniation only, with close BP monitoring. Labeled ICP and IOP doses run over ≥30 min
- Line: the labels prefer a large central vein. ENLS allows a peripheral bolus through a large, well-running IV. Solutions ≥10% cause phlebitis. Extravasation can cause compartment syndrome
- Blood products: never share a set with them (pseudoagglutination, hemolysis). Unavoidable? The label calls for ≥20 mEq sodium chloride per liter of mannitol
- Containers: don't admix. Keep 25% out of PVC bags, where it forms a white precipitate. Never pressurize a flexible bag. Air embolism is the risk
- Urine output: expect brisk diuresis within the hour. Place a urinary catheter. Replace what the patient loses so they stay euvolemic
Dosing Notes:
- Bolus dosing is preferred. A continuous infusion loses effect and raises the risk of rebound edema
- Before every repeat dose, check the osmolar gap, Na⁺, creatinine and urine output
- Renal and hepatic notes: Special Populations
Contraindications & Precautions
Contraindications
- Known hypersensitivity to mannitol
- Anuria
- Severe hypovolemia
- Pre-existing severe pulmonary vascular congestion or pulmonary edema
- Active intracranial bleeding, except during craniotomy (labeled. In ICH with herniation, neurosurgery or neurocritical care makes the call)
Precautions
- Renal impairment or nephrotoxic drugs: the risk of osmotic nephrosis and renal failure goes up. Mannitol builds up and pulls fluid into the circulation
- Heart failure: the first volume expansion can trigger pulmonary edema
- Disrupted blood-brain barrier: repeated or continuous dosing can make the edema worse. Rebound ICP can show up hours after an infusion
- Hypotension or trauma with blood loss: osmotic diuresis drops BP and cerebral perfusion pressure (CPP). Hypertonic saline expands volume instead
Hold / Reassess If
- Hypotension or hypovolemia (low MAP, or CPP falling because BP is falling): stop or slow the infusion, restore volume (vasopressor per protocol if needed) and consider hypertonic saline instead. Low CPP from a rising ICP with an adequate MAP is a reason to give osmotherapy. It is not a reason to hold it. CPP targets: 60–70 mmHg in adults (ENLS). In children it is at least 40 mmHg, with 40–50 mmHg by age (2019 pediatric TBI guidelines)
- Urine output <0.5 mL/kg/hr or rising creatinine: stop. Reassess volume and renal function
- Osmolar gap: NCS 2020 found no validated cutoff. Follow the unit protocol. Some protocols hold the next dose at a gap of ≥20 mOsm/kg. That number is used in practice but never validated. ENLS allows repeat dosing with gap goals of 20–55 mOsm/kg, and adds little benefit at the high end. Do not redose at a gap ≥55 mOsm/kg. That is the level that best tracks a high serum mannitol
- Sodium: an early, brief dip in Na⁺ right after a dose is expected. Mannitol pulls water into the blood while measured osmolality rises. That dip does not by itself need sodium. Correct hyponatremia (Na⁺ <135 mEq/L) that persists or keeps falling, or that comes with neurologic change or renal impairment (mannitol accumulating). Correct any K⁺ derangement. Stop mannitol if a significant fluid or electrolyte imbalance develops. In active herniation, don't delay osmotherapy. If Na⁺ is low, consider hypertonic saline
- Crackles, falling SpO₂, new confusion or seizures: stop. That points to overload or CNS toxicity
Adverse Effects & Toxicity
Common
- Polyuria and volume depletion
- Thirst, dry mouth, nausea, vomiting, headache
- Infusion-site pain and phlebitis
- Shifts in Na⁺ and K⁺ (early dilutional fall in Na⁺, later rise with free-water loss)
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Hypotension, hypovolemia | Falling BP and CPP, tachycardia, high urine output | Stop; isotonic fluid to replace losses; switch to hypertonic saline |
| Acute kidney injury (osmotic nephrosis) | Oliguria, rising creatinine, high osmolar gap; about 6–12% of patients treated with mannitol (NCS 2020, reference 3; Kim 2023, reference 6) | Stop; correct volume; hemodialysis if severe or overloaded |
| Pulmonary edema, heart failure | Dyspnea, crackles, falling SpO₂, especially with renal failure | Stop; oxygen and ventilatory support; dialysis if anuric |
| Electrolyte and acid-base derangement | Stop; correct; cardiac monitoring | |
| CNS toxicity | Confusion, lethargy, seizures, coma; worse with renal impairment | Stop; check osmolality, Na⁺ and gap; supportive care |
| Rebound intracranial hypertension | ICP rises hours after a dose, with repeated or continuous use | Bolus dosing only; taper rather than stop abruptly after prolonged use |
| Hypersensitivity, anaphylaxis | Hypotension, dyspnea, urticaria; cardiac arrest reported | Stop; IM epinephrine and anaphylaxis care |
| Extravasation | Swelling, pain; compartment syndrome reported | Stop; elevate; surgical review if compartment pressures rise |
Overdose & Toxicity Management
- Signs: renal failure, hypo- or hypervolemia, hyperosmolarity, electrolyte imbalance, coma or seizures
- Management: stop the infusion; correct fluids and electrolytes; support cardiac, renal and pulmonary function
- Antidote: none. Hemodialysis removes mannitol. Its half-life is about 6 hr on dialysis, versus about 36 hr in renal failure. CRRT is an option. Peritoneal dialysis is slower
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: neuro exam and pupils | Before and after each dose; continuously in herniation | No improvement in 15–30 min: escalate to the next tier and neurosurgery |
| Clinical: ICP and CPP (if monitored) | Continuously | ICP >22 mmHg (>20 mmHg in children) sustained >5 min: treat; keep CPP 60–70 mmHg in adults, at least 40 mmHg in children (40–50 mmHg by age). Low CPP from high ICP with adequate MAP: osmotherapy is the treatment |
| Clinical: BP and MAP | Frequently during the bolus, then per unit routine | Hypotension or falling MAP: stop or slow the infusion, give volume (vasopressor per protocol if needed), consider hypertonic saline |
| Clinical: urine output and fluid balance | Hourly | <0.5 mL/kg/hr: hold; replace high output with isotonic fluid |
| Clinical: lungs, SpO₂, IV site | During and after each dose | Crackles or hypoxemia: stop; swelling at the site: stop, extravasation care |
| Laboratory: osmolality and osmolar gap | Baseline and before each repeat dose | NCS 2020 found no validated cutoff: follow the unit protocol. Some protocols hold at ≥20 mOsm/kg; ENLS allows repeat dosing up to gap goals of 20–55; do not redose at ≥55. Gap = measured − calculated osmolality |
| Laboratory: Na⁺, K⁺, Cl⁻, HCO₃⁻, Ca²⁺, phosphate | Baseline and before each repeat dose | |
| Laboratory: BUN, creatinine | Baseline and before each repeat dose | Rising creatinine: stop |
| Laboratory: assay interference | Interpreting phosphate and toxic-alcohol results | False-low phosphate and false-positive ethylene glycol by some assays: confirm by another method |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Nephrotoxic drugs (aminoglycosides, cyclosporine) | Higher risk of renal failure; aminoglycosides also add CNS toxicity | Avoid if possible; monitor creatinine and urine output |
| Other diuretics, including furosemide | Potentiate renal toxicity; deeper volume and K⁺ loss | Avoid if possible; if combined, replace losses and check electrolytes |
| Digoxin, QT-prolonging drugs, neuromuscular blockers | K⁺ shifts can trigger arrhythmia or alter blockade | Monitor K⁺ and ECG; stop mannitol if cardiac status worsens |
| Lithium | Early increase in clearance, then toxicity if hypovolemia or AKI develops | Consider holding lithium; check levels often |
| hypertonic saline 3% | Additive osmotic load | Track osmolality, osmolar gap, Na⁺ and fluid balance |
| Dantrolene (conventional vials) | Each 20 mg vial contains 3 g mannitol (Dantrium IV label, reference 11) | Count it toward the osmotic load |
IV Compatibility
- Line: give it its own line or lumen. Don't admix it, don't run blood products in the same set, and keep 25% out of PVC bags
- Check an institutional compatibility resource.
Special Populations
- Pediatrics: the label covers raised ICP and IOP in children but defines no pediatric dose. Children under 2 years face more fluid and electrolyte problems. See the Pediatric Dosing table.
- Neonates: a low glomerular filtration rate (GFR) and limited urine concentration raise the risk of fluid and electrolyte derangement. Monitor closely and bring in neonatology or PICU early. Don't delay a rescue dose for herniation.
- Pregnancy: decades of published case reports have found no drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Mannitol crosses the placenta and may shift fetal fluid. Don't withhold it for herniation. Source: Osmitrol prescribing information, section 8.1 (reference 1).
- Lactation: there are no data on milk levels or infant effects. Weigh the maternal need.
- Older Adults: less renal reserve means more risk of AKI, overload and electrolyte disturbance. Evaluate renal, cardiac and pulmonary status first.
- Renal Impairment: it is contraindicated in anuria. The half-life climbs to about 36 hr in renal failure. Mannitol builds up and causes overload, hyperosmolarity and CNS toxicity. Avoid it, or use it with specialist input. Hemodialysis removes it.
- Hepatic Impairment: no specific adjustment has been established. It is used for cerebral edema in acute liver failure (see Indications).
- Obesity / Dosing Weight: there is no validated dosing weight. Mannitol stays in extracellular fluid (volume of distribution about 17 L in adults). Follow the institutional protocol.
Field & Transport Considerations
- Scope: mostly RN and critical-care transport teams (flight and ground CCT) give or continue mannitol. Ground ALS rarely carries it. Scope varies by state and agency protocol.
- Prehospital TBI: the Brain Trauma Foundation prehospital guidelines (3rd edition, 2023) say no to prophylactic field mannitol or hypertonic saline for suspected raised ICP, with or without signs of herniation (weak recommendation). With active herniation, the call is hyperventilation to an ETCO₂ of 30–35 mmHg, watched on capnography. NCS 2020 suggests against prehospital mannitol to improve neurologic outcome too. In the field, it belongs under a specific protocol or online medical direction only.
- Storage & Stability: keep it at 20–25°C (68–77°F). A brief exposure up to 40°C (104°F) does not harm bags. Protect it from freezing. Cold vehicles and hangars cause crystals, so inspect every bag and vial before use.
- Carried Concentration: the 20% bag is 0.2 g/mL, and the 25% vial is 0.25 g/mL. Convert grams to mL for the product in hand, and say it aloud.
- Infusions in Transport: filter set on a pump; never pressurize the bag; check a peripheral site often for extravasation; empty the urine bag and record output before departure.
- Handoff Essentials: each dose in g and g/kg with start and end times; cumulative 24-hr grams; pupil and GCS trend; BP, CPP and urine output; last osmolality, osmolar gap, Na⁺ and creatinine.
Clinical Pearls
A Bridge, Not a Fix: Mannitol buys minutes to hours. It is never the whole plan. Stack it with head-of-bed elevation to 30°, a midline head, brief hyperventilation for active herniation, and an immediate call to neurosurgery.
Mannitol vs Hypertonic Saline:
- Volume: mannitol expands, then drains off through diuresis. Hypertonic saline expands and stays put
- Blood-brain barrier: the reflection coefficient is 0.9 for mannitol and 1.0 for hypertonic saline. So saline gives less rebound (Kim 2023, reference 6)
- Monitoring: watch the osmolar gap for mannitol and Na⁺ for saline
- Osmolar load: per mL, the two are close. 20% mannitol runs 1,098 mOsm/L and 3% saline 1,027 mOsm/L
- NCS 2020: saline first in TBI and ICH. Either one in stroke and liver failure
Diuresis Can Drop CPP: Hypovolemic trauma patient? Mannitol diuresis drops BP and cerebral perfusion. Replace the urine output with isotonic fluid, or choose hypertonic saline.
Gap Beats Osmolality: Watch the gap, not the raw osmolality. The gap tracks circulating mannitol better. NCS 2020 found the old 320 mOsm/kg ceiling did not predict kidney injury.
Exam Discriminator, Toxic Alcohol Mimic: Mannitol raises the osmolar gap. It can also give a false-positive ethylene glycol result. Before you diagnose a toxic alcohol, ask whether mannitol was given.
Cold Weather Check: Cold is what makes 20% and 25% solutions crystallize. Look before you spike it, and keep the filter set with the bag.
Bolus, Then Taper: A leaky barrier plus continuous infusion or repeated doses lets mannitol into the brain. That drives rebound edema. Give boluses. Taper after prolonged use.
Pharmacology
Mechanism of Action
- Raises plasma osmolality → draws water from brain and eye tissue into the circulation → lowers ICP and IOP; needs an intact blood-brain barrier
- Freely filtered and less than 10% reabsorbed → holds water in the tubule → osmotic diuresis with Na⁺ and Cl⁻ loss
- Early volume expansion → transient rise in BP and CPP; later diuresis lowers intravascular volume
- Partial entry into injured brain (reflection coefficient 0.9; hypertonic saline 1.0; Kim 2023, reference 6) → rebound edema with repeated dosing
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IV (ICP) | 15–30 min | — | 1.5–6 hr |
| IV (IOP) | — | 30–60 min | — |
- Half-life: 0.5–2.5 hr with normal renal function; about 36 hr in renal failure
- Distribution: extracellular fluid within 20–40 min; volume of distribution about 17 L in adults
- Metabolism: minimal
- Elimination: renal, unchanged; about 80% of a dose in the urine within 3 hr
Source: Osmitrol prescribing information (reference 1), sections 12.3 and 7.6 (including false-low phosphate and false-positive ethylene glycol assays).
Names & Classification
- Generic Name
- Mannitol (D-mannitol), injection USP
- Brand Names
- Osmitrol; generic 20% bags and 25% vials. Other mannitol products are not for IV osmotherapy: Aridol (inhaled bronchial challenge), Bronchitol (inhaled, cystic fibrosis), Resectisol (mannitol 5% urologic irrigation, discontinued), sorbitol-mannitol irrigant
- Pharmacologic Class
- Osmotic diuretic (six-carbon sugar alcohol)
- Therapeutic Class
- Hyperosmolar agent for raised ICP and IOP
- Controlled Substance
- Not controlled
- ISMP High-Alert
- No
- Look-Alike / Sound-Alike
- No ISMP-listed pair identified; confirm the concentration (20% bag vs 25% vial) when converting grams to mL
References
- Baxter Healthcare Corporation. (2025). Osmitrol (mannitol injection), for intravenous use: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d914965-7001-45cb-ba51-d7c5964b05bc
- Hospira, Inc. (2024). Mannitol Injection 25%, USP, for intravenous use: Prescribing information (revised November 2024; DailyMed listing updated April 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ad3145e-00e7-4412-b9a5-06f00f264f30
- Cook, A. M., Morgan Jones, G., Hawryluk, G. W. J., et al. (2020). Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocritical Care, 32(3), 647–666. https://doi.org/10.1007/s12028-020-00959-7
- Bhalla, P., Dingman, J. S., & Aysenne, A. (2024). Emergency Neurological Life Support: Intracranial hypertension and herniation protocol, version 6.0. Neurocritical Care Society. https://www.neurocriticalcare.org/Portals/0/ENLS%205.0/ENLS%206.0/Protocol%20V6_0_Intracranial%20Hypertension%20and%20Herniation.pdf
- Lulla, A., Lumba-Brown, A., Totten, A. M., et al. (2023). Prehospital guidelines for the management of traumatic brain injury, 3rd edition. Prehospital Emergency Care, 27(5), 507–538. https://doi.org/10.1080/10903127.2023.2187905
- Kim, J. H., Jeong, H., Choo, Y.-H., et al. (2023). Optimizing mannitol use in managing increased intracranial pressure: A comprehensive review of recent research and clinical experiences. Korean Journal of Neurotrauma, 19(2), 162–176. https://doi.org/10.13004/kjnt.2023.19.e25
- Glaser, N., Fritsch, M., Priyambada, L., et al. (2022). ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes, 23(7), 835–856. https://doi.org/10.1111/pedi.13406
- Kochanek, P. M., Tasker, R. C., Carney, N., et al. (2019). Guidelines for the management of pediatric severe traumatic brain injury, third edition: Update of the Brain Trauma Foundation guidelines. Pediatric Critical Care Medicine, 20(3S Suppl 1), S1–S82. https://doi.org/10.1097/PCC.0000000000001735
- Prabhakaran, S., Gonzalez, N. R., Zachrison, K. S., et al. (2026). 2026 Guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association/American Stroke Association. Stroke, 57(8). https://doi.org/10.1161/STR.0000000000000513
- Carney, N., Totten, A. M., O'Reilly, C., et al. (2017). Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery, 80(1), 6–15. https://doi.org/10.1227/NEU.0000000000001432
- Par Health USA, LLC. (2025). Dantrium Intravenous (dantrolene sodium for injection): Prescribing information (revised December 2025; DailyMed listing updated March 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4df35098-8702-46be-ac67-30cfdf1aa570
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