How to taper lasix,manitol in head injury patients..any perfect guideline??

The aim is to reduce brain oedema in head injury Both drugs are synergistic Tappering will depend on signs of recovery Vitals should be consistant 02 saturation bp pulse beside consciousness and orientation to time and place Local signs should improve Simultaneously electrolytes balance should be watched

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Mannitol produced a dose-dependent increase in plasma osmolality and reduction of brain water content. There was a linear relation between plasma osmolality and brain water content. Furosemide alone did not affect plasma osmolality or brain water at any dose. The combination of furosemide with mannitol resulted in a greater increase in plasma osmolality than seen with mannitol alone and a greater decrease in brain water at 4 and 8 g/kg of mannitol. Conclusions: The doses of mannitol and furosemide utilized were much larger than clinically applicable doses and were selected to maximize the ability to detect effect on brain water. The combination of mannitol and furosemide resulted in greater reduction of brain water content than did mannitol alone. Furosemide enhanced the effect of mannitol on plasma osmolality, resulting in a greater reduction of brain water content. Potential interaction (if any) of smaller, clinically used doses of mannitol and furosemide cannot be surmised from the current study Head injuries range from a bump on the head to a skull fracture. Some head injuries are severe enough to cause brain damage or even death. Knowing the symptoms of a concussion and some simple first aid can help people respond to a head injury quickly, reducing the chances of complications. People can often treat mild head injuries at home. Applying a cold pack to the area can help to reduce swelling. A person can also take Tylenol but should avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, Medication:- Osmotic diuretics mannitol (Rx) Anticonvulsants phenytoin (Rx) Electrolytes:- magnesium sulfate (Rx) Barbiturates:-pentobarbital (Rx) Calcium Channel Blocker:-nimodipine (Rx) Stimulants:-methylphenidate (Rx) Dopamine agonist:-levopoda(Rx) Selective serotonin reuptake inhibitors:-sertraline (Rx) Antispasticity medications:-tizanidine (Rx),baclofen (Rx)diazepam (Rx)etc N-Methyl-D-Aspartate Receptor Antagonists:-dextromethorphan/quinidine (Rx),

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Both drugs are have synergistic effect in reducing brain water ultimately brain edema. Should be tapered according to severity of brain injury . Simultaneously we must monitor electrolytes and correct accordingly and taper the doses on individual pt responses . Merits and demerits should be weighed against each other maintaining the electrolyte levels .

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Neutrophil 800mg tab iv manitol 20 mg daily one three days pregalin nt tab

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