A 31-year-old woman was transferred because of dyspnea that occurred immediately after cesarean section. Initial echocar-diography showed akinesia in apex to mid left ventricular (LV) wall with severe LV systolic dysfunction, which was pre-sumed to be stress-induced cardiomyopathy. Because the patient developed cardiogenic shock, we initially planned on inser-tion of an intra-aortic balloon pump. However, due to aggravation of cardiogenic shock and pulmonary edema, we had to resort to extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support. In addition, an LV pigtail catheter was applied for decompressing the LV. Finally, she was successfully weaned from ECMO after recovery of LV function.

Mannitol is commonly used to reduce intracranial and intraocular pressures and to prevent dialysis-disequilibrium syndrome. However, intravenous mannitol infusion in various cases has the potential to result in acute kidney injury (AKI). We present a case of mannitol-induced AKI that developed after low dose mannitol infusion and resulted in recovery after hemodialysis. A 66-year-old woman was admitted to the hospital with a diagnosis of left middle cerebral artery infarction. On hospital day 5, cerebral edema was observed on a follow-up MRI. D-mannitol 35 g was given intravenously every 8 hours. Four days later, serum creatinine levels were elevated from 1.2 mg/dL to 3.5 mg/dL. The serum osmolal gap was found to be 52.4 mosm/kg H2O and urine output was reduced from 2.78 mL/kg/h to 0.69 mL/kg/h over three days. Hemodialysis over 2 hours was performed and renal function subsequently improved to baseline function. A potential risk of AKI exists even with low dose mannitol infusion in patients with advanced age, underlying renal impairment, and concomitant use of nephrotoxic agents. Mannitol-induced AKI may be rapidly reversed by short-term hemodialysis.