BIOCORE JOURNALS

Objective: To demonstrate Starling’s law is wrong by summarising the substantial evidence on the hydrodynamic of the porous orifice (G) tube.

Material and methods: Focussed open mind narrative review of the substantial evidence on the hydrodynamic of the G tube that proves Starling’s law wrong is presented. It provides the replacement for explaining the capillaryinterstitial fluid transfer.

Result: The G tube has negative side pressure (SP) gradient that is maximum negative near the inlet and turns gradually positive to become maximum near the exit. Thus, in the G tube suction or absorption of fluid occurs through side holes near the inlet while filtration occurs through holes near the exit. This creates autonomous rapid dynamic magnetic field-like fluid circulation in a surrounding chamber (C) between fluid around the G tube and fluid inside its lumen. The negative SP of G tube creates net negative pressure in chamber (C) with a direction of flow opposite to that in the G tube.

Conclusion: Both physics and physiological evidence demonstrate that the capillary works as G tube in which the arterial pressure induce negative SP gradient that causes absorption by suction not filtration. Starling’s law is thus proved wrong on both forces and equation. Starling’s law being wrong has resulted in many errors and misconceptions on fluid therapy that mislead physicians into giving too much fluid during the resuscitation of shock. The resulting VO induce VO shocks (VOS): Sodium-free fluid induce VOS 1 and sodium-based fluid induce VOS 2. Examples of VOS 1 is the TUR syndrome known in urology also as hyponatremic shock. This VOS 1 is always mistaken for a known shock and is wrongly treated with further volume expansion that transfer VOS 1 into VOS 2. The later VOS 2 may also complicate fluid therapy of recognized shocks. This is in turn cause ARDS. 

Objectives: To demonstrate that Volumetric overload (VO) is the correct patho-aetiology of the TUR syndrome, dilutional hyponatraemia (DH) and ARDS while the toxic/septic hypothesis are as innocent as the wolf in Josef story.
Materials and Methods: Using model standard based on anonymous peer review for critical analytical criticism of an article by the world authority on fluid therapy, volume kinetic (VK) and proponent of the toxic hypothesis of the TUR syndrome contrasted with the author’s theory of volumetric overload in the patho-aetiology of the TUR syndrome, DH and ARDS as based on proved Starling’s law wrong.
Results: VOS causes ARDS. It is an iatrogenic complication of fluid therapy in hospitals that is overlooked and under-estimated. VOS is 2 types: VOS 1 and VOS 2. VOS 1 is induced by 3.5-5 L of mostly sodiumfree fluid and is characterized with dilution HN that has 2 nadirs and 2 paradoxes, is most dynamic and illusive and has a lifesaving therapy of HST. VOS 2 may complicate VOS 1 or may be de novo complicating sodium-based fluid therapy during resuscitation of shock, acutely ill patients, and prolonged surgery. It has no obvious serological markers or none. Many errors and misconceptions mislead physicians into giving too much fluid for resuscitation due to faulty rules on fluid therapy dictated by the wrong Starling's law that induces VOS 2 causing ARDS. The correct replacement for this law is the hydrodynamic of the G tube. Discovery of VOS has resolved the puzzles of TUR Syndrome, HN and ARDS for which a new therapy using HST of 5%NaCl and/or 8.4%NaCo3 is recommended.