In patient of head injuries with rapidly increasing intracranial tension without hematoma, the drug of choice for initial management would be

Mannitol Mannitol is widely used to reduce ICP Commonly used preparation : 20% solution, 0.25-1 gm/kg is given IV as bolus Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failure. Uses of mannitol To reduce increased ICT or intra ocular tension To maintain GFR and urine flow in impending renal failure Forced diuresis in hypnotic or other poisoning To counteract low osmolality of plasma/ECF due to rapid hemolysis or peritoneal dialysis Contraindications of Mannitol Acute Tubular Necrosis Anuria Pulmonary edema Acute left ventricular failure CHF Cerebral hemorrhage Ref :Harrison's 19th edition Pgno :1779-1780