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Circulatory overload due to expansion of extracellular fluid is a serious adverse effect of mannitol; as a consequence, pulmonary oedema can be precipitated in patients with diminished cardiac reserve, and acute water intoxication may occur in patients with inadequate urine flow. So, as interstitial oedema is determined by starling's forces, it is possible that the increased hydrostatic pressure created by the manitol offsets the increased oncotic pressure leading to extravasation of fluid.

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