Twenty-one Reasons Affirming Starling’s Law on the Capillary-interstitial Fluid Transfer Wrong and the Correct Replacement is the Hydrodynamic of the Porous Orifice (G) Tube

Many reasons why Starling’s law wrong and the correct replacement is the hydrodynamic of porous orifice (G) tube exist. Starling’s hypothesis is based on Poiseuille’s work in which the hydrostatic pressure causes filtration. The oncotic pressure force of plasma proteins causes re-absorption. Starling’s law is wrong on both forces. The capillary has a pre-capillary sphincter and pores that allow the passage of plasma proteins. This makes the capillary a porous orifice (G) tube with different hydrodynamic; side pressure causes suction not filtration. The pores nullify the oncotic force in vivo. There is evidence to show that the osmotic chemical composition of various body fluids is identical to plasma proteins. The interstitial fluid (ISF) space has a negative pressure of -7 cm water. Evidence on Albumin versus Saline for fluid resuscitation shows no significant difference. This affirms that the oncotic force does not exist in vivo that partly prove Starling’s law wrong. Inadequacy in explaining the capillary–ISF transfer, has previously called for reconsideration of Starling’s hypothesis. Physics and physiological research demonstrate that pressure does not cause filtration across the wall of G tube, it causes suction. In G tube negative side pressure gradient causing suction maximum near the inlet and turns positive maximum near the exit causing filtration. Physiological study completed the evidence that Starling’s law is wrong as the capillary works as G tube not Poiseuille’s tube. Both absorption and filtration are autonomous functions of G tube thus fit to replace Starling’s law. The clinical significance is discussed.

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The Correct Replacement for the Wrong Starling’s law is the Hydrodynamic of the Porous Orifice (G) Tube: The Complete Physics and physiological Evidence with Clinical Relevance and Significance

Cardiology Open Access ◽

10.33140/coa.05.01.02 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Arterial Pressure ◽

Clinical Relevance ◽

Plasma Proteins ◽

Case Series ◽

Clinical Importance ◽

Oncotic Pressure ◽

Starling’S Law ◽

Physiological Evidence ◽

Side Pressure ◽

Clinical Syndromes

Introduction and objective: To report the complete evidence that Starling’s law is wrong and the correct replacement is the hydrodynamic of the G tube. New physiological evidence is provided with clinical relevance and significance. Material and methods: The physics proof is based on G tube hydrodynamic. Physiological proof is based on study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema. The clinical significance is based on 2 studies one prospective and a 23 case series on volumetric over load shocks (VOS). Results: Hydrodynamic of G tube showed that proximal, akin to arterial, pressure induces suction “absorption” not “filtration”. In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis, The physiological evidence proves that the capillary works as G tube not Poiseuille’s tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or plasma proteins. The wrong Starling’s law dictates the faulty rules on fluid therapy inducing VOS and causing ARDS. Conclusion: Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed.

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Final proof Starling’s law wrong and G tube hydrodynamic is the correct replacement: New results and critical analytical criticisms of landmark articles

Biomedical Research and Clinical Reviews ◽

10.31579/2692-9406/035 ◽

2021 ◽

Vol 3 (2) ◽

pp. 01-29

Author(s):

Ahmed N. Ghanem

Keyword(s):

Interstitial Fluid ◽

Dynamic Pressure ◽

Strenuous Exercise ◽

Substantial Evidence ◽

Starling’S Law ◽

Side Pressure ◽

The Difference ◽

Fluid Transfer ◽

Precapillary Sphincter ◽

The Magnetic Field

Substantial evidence demonstrating Starling’s law is wrong currently exists. This article presents the final definitive proof that Starling’s law is wrong, and the correct replacement is the hydrodynamic of the G tube. The presented evidence is based on reported and new results of the G tube hydrodynamic and critical analytical criticism of landmark and contemporary impactful articles. The objectives of this article are to affirm applicability to capillary; crossing the editors’ barrier to convince the hardest of critics that the new theory is correct. The new results presented here further affirm this and the critical analytical criticisms reveal many errors that has misled authors into reporting erroneous results and conclusions affirming Starling’s law and its equations are wrong. The new results show the difference between the hydrostatic pressure and the two components of dynamic pressure: Flow and Side pressures. The side pressure is a negative pressure gradient exerted on the wall of G tube built on a scale to capillary ultrastructure of precapillary sphincter and the wide intercellular cleft pores in its wall. This affirms Starling’s law and its equation are wrong and its correct replacement is the magnetic field like phenomenon of the G tube that explain the fast capillary interstitial fluid transfer necessary for viability of cells at rest and during strenuous exercise.

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Osmotic interaction of plasma proteins with interstitial macromolecules

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1976.231.2.638 ◽

1976 ◽

Vol 231 (2) ◽

pp. 638-641 ◽

Cited By ~ 22

Author(s):

CA Wiederhielm ◽

LL Black

Keyword(s):

Plasma Proteins ◽

Ringer Solution ◽

In Vivo Studies ◽

Tissue Fluid ◽

Oncotic Pressure ◽

Mixed Solutions ◽

Probable Role

The osmotic interaction of plasma proteins with collagen and hyaluronate has been evaluated by measuring the oncotic pressure of mixed solutions of varying composition. Collagen, despite its insolubility, exhibits a pronounced volume exclusion effect on plasma proteins, and the oncotic pressure of mixed solutions is considerably higher than that of the plasma protein stock solution. The volume exclusion of collagen on small molecules such as sucrose is negligible. A solution composed of 1.6% plasma proteins, 20% collagen, and .4% hyaluronate in Ringer solution, approximating the composition of the interstitium, was found to yield higher oncotic pressures than those previously reported from the interstitium. The probable role of impurities and degradation in the isolation process is discussed. Results reported earlier from in vitro and in vivo studies indicated that tissue oncotic pressures are considerably higher than generally recognized and that tissue fluid is in probable osmotic equilibrium with lymph in skin and muscle.

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Anomalous fractional clearance of negatively charged Ficoll relative to uncharged Ficoll

AJP Renal Physiology ◽

10.1152/ajprenal.00370.2002 ◽

2003 ◽

Vol 285 (6) ◽

pp. F1118-F1124 ◽

Cited By ~ 32

Author(s):

Marco A. M. Guimarães ◽

Julijana Nikolovski ◽

Lynette M. Pratt ◽

Kerryn Greive ◽

Wayne D. Comper

Keyword(s):

Steady State ◽

Plasma Proteins ◽

Capillary Wall ◽

Short Term ◽

Charge Selectivity ◽

Significant Difference ◽

Fractional Clearance ◽

Excretion Rates ◽

Approach To Steady State

Recent studies, using low-temperature perfusion of rat kidneys, have claimed the existence of renal charge selectivity simply on the basis of the differential excretion rates of uncharged Ficoll and charged proteins. To test for the existence of charge selectivity in vivo, we examined the clearance of negatively charged Ficoll compared with uncharged Ficoll. A short-term approach to steady state was used to study the fractional clearances. Relative clearances were also examined using an osmotic pump technique where the tracers reach a steady-state value in conscious rats after 7 days. Carboxymethyl Ficoll was stable during filtration and renal passage, was not taken up by the kidneys, and did not bind to plasma proteins. There was no significant difference in the fractional clearance of molecules with radius of 36 Å for Ficoll (fractional clearance = 0.048 ± 0.038, n = 5) and negatively charged carboxymethyl Ficoll (fractional clearance = 0.028 ± 0.019, n = 5). For molecules with radii greater than 36 Å, carboxymethyl Ficoll had facilitated clearance with respect to uncharged Ficoll [for example, at a radius of 60 Å fractional clearance for Ficoll = 0.0012 ± 0.0005 ( n = 5), whereas that for carboxymethyl Ficoll = 0.015 ± 0.005 ( n = 5)]. Renal function was not compromised by carboxymethyl Ficoll as uncharged Ficoll in urine exhibited similar hydrodynamic size profiles when studied in the presence of excess unlabeled carboxymethyl Ficoll. The facilitated clearance of negatively charged Ficoll with respect to uncharged Ficoll reveals a property of the capillary wall, which has been previously observed with other nonproteinaceous polyanions. This study demonstrates that the glomerular capillary wall is not charge selective in the form of excluding negatively charged Ficoll. However, the charge properties of the capillary wall may influence the facilitated transport of charged Ficoll compared with uncharged Ficoll.

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What is Misleading Physicians into Giving Too Much Fluid during Resuscitation of Shock and Surgery that Induces ARDS and/or AKI?

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2020/asjbccr.6192 ◽

2020 ◽

Vol 3 (1) ◽

pp. 90-98

Author(s):

Ghanem AN

Keyword(s):

Arterial Pressure ◽

Fluid Therapy ◽

Clinical Studies ◽

Plasma Proteins ◽

Case Series ◽

Clinical Importance ◽

Starling’S Law ◽

Physiological Evidence ◽

Side Pressure ◽

Objective Evidence

Introduction and Objective: Evidence demonstrates that there are many errors and misconceptions on fluid therapy. Starling’s law underlies it all. This report gives the complete evidence that Starling’s law is wrong on both forces and the correct replacement is hydrodynamic of the G tube. New physiological evidence is provided with clinical relevance and significance. Material and Methods: The physics proof is based on G tube hydrodynamic. The physiological proof is based on a study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema. The clinical significance is based on 2 studies one prospective and a 23 case series on volumetric overload shocks (VOS). The recent clinical studies on albumin and hydroxyethyl starch versus saline and also that on plasma proteins partly affirm that Starling’s law is wrong. My physics and physiological research completes this evidence. Results: Hydrodynamics of G tube showed that proximal, akin to arterial, pressure induces suction “absorption”, not “filtration”. In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis. The physiological evidence proves that the capillary works as G tube not Poiseuille’s tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or plasma proteins, neither in physiological nor in clinical studies. The wrong Starling’s law dictates the faulty rules on fluid therapy misleading physicians into giving too much fluid during shock resuscitation and surgery inducing VOS and ARDS. Conclusion: Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed.

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