saline + mannitol + furosemide

This is a combination therapy consisting of three agents: - **Saline** (sodium chloride solution): An isotonic or hypertonic intravenous fluid used for hydration, electrolyte balance, and as a vehicle for drug delivery. - **Mannitol**: An osmotic diuretic that increases plasma osmolality, drawing water out of tissues (notably the brain) into the bloodstream to reduce intracranial and intraocular pressure. It also promotes diuresis by inhibiting water reabsorption in the renal tubules[5][7][8]. - **Furosemide**: A loop diuretic that inhibits sodium and chloride reabsorption in the ascending limb of the loop of Henle, leading to increased excretion of water, sodium, potassium, calcium, and magnesium. It is used to treat edema associated with heart failure, liver cirrhosis, renal disease, hypertension, and acute pulmonary edema[2][6][8]. The combination is primarily used in clinical settings for aggressive management of fluid overload states or conditions requiring rapid reduction in tissue swelling—such as cerebral edema or prevention/treatment of nephrotoxicity during high-dose cisplatin chemotherapy. The rationale behind this regimen is synergistic diuresis through different mechanisms (osmotic effect from mannitol; natriuretic effect from furosemide), with saline providing volume support to prevent hypovolemia[1][3]. This approach may be considered when single-agent therapy fails or when maximal reduction in tissue fluid is required.