Which drug would be used to treat increased intracranial pressure (ICP) resulting from cerebral edema?

• A. Sodium bicarbonate
• B. Mannitol
• C. Atropine sulfate
• D. Epinephrine hydrochloride

Answer: (B)

When brain swelling drives a rise in pressure, the goal is to reduce brain water content quickly. Mannitol works by acting as an osmotic agent that raises the osmolality of the blood and stays largely within the vascular space long enough to draw water out of swollen brain tissue into the bloodstream. This shift decreases the volume of brain parenchyma and lowers intracranial pressure, often with rapid effect. It’s given IV as a bolus with careful monitoring of urine output, electrolytes, and hydration status to prevent dehydration or electrolyte imbalances, and it should be avoided in patients with certain renal issues or significant fluid overload. The other drugs listed don’t reduce intracranial water content—sodium bicarbonate addresses metabolic acidosis, atropine affects heart rate and secretions, and epinephrine is used for life‑threatening allergies or cardiac emergencies, not ICP management.