本文報告一位84歲男性病患，因左側中腦動脈大範圍梗塞導致腦水腫，以mannitol 降低顱內壓，使用63小時累積劑量225g後，發生急性寡尿腎衰竭，在排除其他藥品及可能導致急性腎衰竭的相關因素，並經由Naranjo“不良反應與藥品相關性的評估”結果，認為極有可能是mannitol造成的急性腎衰竭，經停藥並施行血液透析治療後，病患尿量增加，腎功能回復。文中藉由案例報告及文獻資料回顧，探討mannitol造成急性腎衰竭的致病機轉、危險因子和處置方式以及預防的方法。

We report a 84-year-old man admitted due to left middle cerebral artery (MCA) large infarction with progressive mass effect. Mannitol was used to decrease cerebral edema. After receiving mannitol 225g during a time period of 63 hours, patient had an acute oligouria renal failure. Excluding other medications and diseases as causes of acute renal failure, it is probable that acute renal failure was caused by mannitol. Urine amount increased and renal function improved after discontinuation of mannitol and removal of mannitol by hemodialysis. The previous case reports and clinical literature on mannitol related acute renal failure, its potential mechanisms, risk factors, prevention and management were reviewed and discussed.