Is mannitol combined with furosemide a new treatment for refractory lymphedema? A case report

Table 1 Laboratory findings during hospitalization

	Baseline	HD 1	HD 2	HD 3	HD 4	HD 5	HD 7	HD 9	HD 11	HD 13	HD 15	HD 17	HD 19	HD 21	HD 48	HD 58	HD 65	HD 77	HD 85	HD 95	HD 108	HD 115	HD 129
Na (mEq/L)	-	140	140	139	145	150	144	142	144	145	140	135	138	138	142	145	148	139	142	136	139	135	133
K (mEq/L)	-	3.0	3.0	2.9	3.1	2.8	2.9	2.8	3.4	3.5	3.6	3.6	3.9	3.8	3.8	3.3	3.9	3.0	4.1	4.3	4.1	4.5	4.4
Cl (mEq/L)		105	105	106	111	114	111	105	107	110	108	106	108	104	110	107	117	110	114	108	107	102	100
Cr (mg/dL)	0.7	0.82	0.83	0.84	0.77	0.68	0.68	0.67	0.74	0.64	0.57	0.54	0.53	0.52	0.51	0.58	0.59	0.57	0.55	0.78	0.65	0.68	0.66
eGFR (mL/min per 1.73 m2)	77	63	62	61	68	77	77	78	72	79	82	83	84	84	85	81	81	82	83	67	78	77	78
BUN (mg/dL)	-	25.2	21.2	40.5	45.1	38	26.1	24	27.8	24.9	31.3	27.1	30	30.4	23.8	16.1	25.9	15.3	17.5	29.5	20.3	19.3	24.6
sOsm (mOsm)	-	302	302	309	323	325	305	308	308	313	305	295	294	296
pH	-	-	7.356	7.492	7.465	7.491	7.508	7.505	7.492	7.513	7.477	7.473	7.456	7.457
pCO2 (mmHg)	-	-	33.3	30.5	35.6	36.3	37.3	38.2	39.0	35.1	35.3	34.8	36.6	38.2
pO2 (mmHg)	-	-	117	108	84.6	109	71.1	137	122	97.1	129	146	100	102
HCO3- (mmol/L)	-	-	18.1	23.1	25.2	27.5	29.3	29.9	29.6	28.0	25.8	25.2	25.4	26.6
BE (mmol/L)	-	-	-6.1	0.7	2.1	4.4	6.3	6.7	6.2	5.3	2.8	2.1	2.0	3
SaO2 (%)	-	-	98.5	98.8	96.9	98.7	95.7	99.0	98.8	97.6	98.7	99.2	97.9	98.2

HD: Hospital day; Na: Sodium; K: Potassium; Cl: Chloride; Cr: Creatinine; eGFR: Estimated glomerular filtration rate; BUN: Blood urea nitrogen; sOsm: Serum osmolarity; pCO₂: Partial pressure of carbon dioxide; pO₂: Partial pressure of oxygen; HCO₃^-: Bicarbonate; BE: Base excess; SaO₂: Oxygen saturation.

Table 2 Current treatments for lymphedema[2,3]

Current treatments
Conservative treatment	Complete decongestive therapy: Manual lymphatic drainage; Multilayer bandaging; Physical therapy; Skin care
	Intermittent pneumatic compression
	Compression garments
Surgical treatment	Lymphovenous anastomosis
	Liposuction
	Debulking surgery (excision of lymphatic tissue)