Experimental use of raffinose as an osmotic agent for peritoneal dialysis.

Conventional glucose-based solutions for peritoneal dialysis fluids have been shown to raise problems of biocompatibility. We therefore evaluated the ultrafiltration capabilities of raffinose as an alternative osmotic agent in a non-uremic rat model. Animals were divided into four groups and injected intraperitoneally with solutions containing raffinose (4.5%, 345 mOsm/kg; 16.7%, 518 mOsm/kg) or glucose (1.5%, 346 mOsm/kg; 4.25%, 489 mOsm/kg). Data obtained from animals exposed to 16.7% raffinose were excluded because of precipitation of the osmotic agent. Low-osmolality raffinose solution induced higher ultrafiltered volume than the low-osmolality glucose-enriched fluid at 120 minutes of dwelling time. No significant differences were observed in effluent sodium and potassium concentration and protein dialysate-to-plasma (D/P) ratio. The D/P ratio of phosphate was higher in the low-osmolality raffinose-based fluid than in the low-osmolality glucose solution. The osmolality of the solutions was significantly decreased after a dwelling time of 120 minutes. We conclude that 4.5% raffinose is an effective osmotic agent. Total or partial replacement of glucose by raffinose for clinical peritoneal dialysis could be eventually considered after appropriate evaluation of its biocompatibility and general side effects.

The emerging role of the social worker in a psychiatric emergency service.

A unique round- the- clock service has evolved out of the need to provide extended emergency coverage in the Milwaukee County Mental Health Center despite the dearth of psychiatric personnel. Psychiatric social workers, who see themselves as specialists in social functioning, have developed a combined intake-evaluation unit that sees all walkins, discusses prospective admissions, and considers alternatives to hospitalization. Using crisis intervention-psychiatric emergency criteria, they determine with applicants and referral sources the degree of disruption, the need for immediate action, and the most appropriate facility to handle the current situation. This is seen as a new extension of the traditional social work role, in the context of community mental health developments.