Finding the Right Osmotic Agent: Why Mannitol Prevailed

By Eelco F. M. Wijdicks
First Online: 09 February 2021

For decades, surgeons and neurosurgeons sought ways to shrink the brain to reduce compression from a mass. The simple physiologic concept of osmosis was well known, and as early as 1918, intravenous glucose was used to attract water from tissues to combat severe dehydration [1]. In his chairman’s address at the annual session of the American Medical Association, Major Litchfield explained: “This taking of water from the tissues may be assumed to remove specific toxins and waste products with it in solution. The glucose is quickly taken up from the blood by the tissues, and this set free the water either for elimination from the kidneys or for utilization in the body protoplasm.” He concluded, “Many medical officers have become enthusiastic advocates of this measure from their observation of its results in cases of meningitis, pneumonia, typhoid fever, septic peritonitis, empyema and brain abscess.”

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