Mannitol is usually indicated for the treatment of neurological symptoms during the acute phase of CP. The dose of mannitol generally recommended is 0.5 à 1g/kg of body weight over a 30-45 minutes period, administered within 48-72h after the consumption of the toxic fish, for maximum efficiency. However, improvements have been observed, even up to several weeks after intoxication.

Please note: As mannitol causes intracellular dehydration, it should be administered once the patient is correctly rehydrated, especially if one suffer from severe diarrhea or vomiting. In addition, mannitol should be avoided for patients with cardiac failure.

Many hypotheses have been suggested to explain the mechanisms of action of mannitol: its osmotic properties, chelator of free radicals and/or inhibitor of successive depolarizations induced by ciguatoxins.

Although controversial, the use of mannitol in the acute, and chronic, phase is recommended in most studies.

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