In cisplatin hydration protocols, which adjunct is sometimes used with aggressive IV fluids to further reduce nephrotoxicity?

• A. Furosemide
• B. Potassium chloride
• C. Mannitol
• D. Dextrose

Answer: (C)

The idea is to maximize renal flushing to dilute and remove cisplatin from the kidneys, reducing tubular exposure and injury. Aggressive IV hydration increases urine flow and renal perfusion, which already helps lower nephrotoxicity risk. Adding an osmotic diuretic like mannitol further boosts urine output by drawing water into the tubules, enhancing tubule flushing and helping to keep the cisplatin concentration in the nephron low. That osmotic effect is why mannitol is the adjunct sometimes used with aggressive hydration.

Furosemide can raise urine output, but it’s a loop diuretic rather than an osmotic one, and it doesn’t provide the same tubular flushing advantage as mannitol; it may also cause electrolyte imbalances if not monitored closely. Potassium chloride is just a potassium supplement, not a protective agent for the kidneys. Dextrose solutions are for hydration but do not offer the specific diuretic/flushing effect that helps mitigate cisplatin nephrotoxicity.