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The correct replacement for the wrong Starling

Ahmed N. Ghanem

 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 detailed. 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 cases series on volumetric overload 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 albumin. The wrong Starling's law dictates the faulty rules on fluid therapy inducing VOS 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. The puzzles of TURP syndrome, Dilution HN and ARDS are resolved.