During an in situ simulation involving a case that require neuroprotection measures, it was discovered that 20% Mannitol precipitated / crystallised in the air conditioned resuscitation room. Although Hypertonic Saline is first line (what was used in the scenario) - it should be noted that this is a potential issue if Mannitol is required / recommended by the Neurosurgical / Critical Care teams.
This has been reported elsewhere
Luckily Mannitol is not first line for raised ICP in current guidelines. It is still on many formularies and is used in other situations. Therefore we decided to change the Mannitol stored in the resuscitation room to 10% Mannitol as the Pharmacy team felt that warming the product up quickly to dissolve the crystals could destabilise the liquid and was not recommended
