To date, there is no established protocol for the management of this osmotic headache, which causes a very significant detriment in the quality of life of hemodialysis patients, 7,8 For this reason, a series of cases are presented in which an alternative 9 protocol is piloted for its management, with mannitol, in view of the prevalence of this problem and the lack of response to conventional medication. Work presented at the Latin American Congress of Nephrology 2012, in the Poster category (TLP-SAB406). ObjectiveTo evaluate the efficacy of mannitol on symptoms compatible with hemodialysis imbalance within a defined protocol, and to determine the side effects associated with the use of mannitol in patients with end-stage renal disease treated with hemodialysis.