The proof and reasons that Starling’s law for the capillary-interstitial fluid transfer is wrong, advancing the hydrodynamics of a porous orifice (G) tube as the real mechanism

Abstract

Introduction and objective: In 1886, Starling proposed a hypothesis for the capillary-interstitial fluid (ISF) transfer, in which the capillary was thought a tube of a uniform diameter that is impermeable to plasma proteins. The flow of fluid across its wall was thought dependent upon a balance between the hydrostatic pressure within its lumen causing 'filtration', and the osmotic pressure of plasma proteins causing 'absorption'. The physical basis on which LP of a capillary was thought positive and responsible for filtration was Poiseuille's work on long Brass tubes of uniform diameters. Later discoveries demonstrated that the capillary is a porous orifice tube with totally different hydrodynamics that is reported here. Material and methods:The hydrodynamics of an inlet tube was studied in order to demonstrate the negative side pressure (SP) gradient exerted on its wall. We then studied the porous orifice (G) tube akin to capillary and later enclosed it in a chamber (C), akin to interstitial fluid space, making the G-C apparatus demonstrating the G-C circulation phenomenon. The effect of proximal (arterial) pressure (PP), distal (venous) pressure (DP) and inlet diameter on the SP and CP of the G-C model are reported. Result:The PP induces the negative SP in the G tube which is responsible for absorption. The orifice has an inverted bell shaped effect on SP and CP. The DP augments filtration. The G tube enclosed it in a chamber (C), making the G-C apparatus demonstrating the G-C circulation phenomenon. Conclusion:Hydrodynamic studies on G tube, based on capillary ultrastructure, demonstrate results which differ from Poiseuille's in a strait tube, challenge the role attributed to arterial pressure as a filtration force in Starling's hypothesis. A perspective literature review shows that the oncotic pressure force has been previously cancelled and the Starling's hypothesis has failed to explain the capillary-ISF transfer in most parts of the body.A concept based on a new hydrodynamic of the G-C model phenomenon is proposed for the capillary-ISF circulation. An autonomous dynamic magnetic field-like G-C circulation occurs between fluid in the G tube's lumen and a surrounding fluid compartment C. Based on results of studies on a circulatory model incorporating the G-C apparatus, factors which initiate, regulate and affect the G-C circulation, its physiological and haemodynamic relevance and its clinical importance to the pathogenesis of oedema and shock are discussed.

The Physiological Proof that Starling's Law for the Capillary-Interstitial Fluid Transfer is Wrong: Advancing the Porous Orifice (G) Tube Phenomenon as Replacement

“…We then studied the porous orifice (G) tube akin to capillary and later enclosed it in a chamber (C), akin to interstitial fluid space, making the G-C apparatus demonstrating the G-C circulation phenomenon. The results of physical experiments was reported [18,19] but summarized here in order to facilitate the understanding of the results of physiological experiments reported here. The factors affecting the speed and efficiency of the G-C circulation were evaluated.…”

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“…He confirmed the effectiveness of hypertonic 5% NaCl or 8.4% Sodium Bicarbonate both as anecdotal evidence [42] and in a prospective study [1,2] and also investigated the underlying faulty physiological law of Starling for the capillary interstitial fluid transfer [43,44]. The results of a career life investigation which aimed at quantifying volumetric gain and its relation to the TURP syndrome highlighting VOS are now reported.…”

“…The fact that the capillary is encircled at the inlet by the pre-capillary sphincter inspired the suggestion that it may induce a Venturi effect. Further studies have revealed the totally different roles of the arterial and venous pressures in regulating simulated capillary-interstitial fluid transfer [43,44]. In the light of these new findings, future studies are justified in order to explore the effects of volumetric overload on vascular pressures and tissue perfusion, as this may prove relevant to the pathogenesis of multiple organ failure and the adult respiratory distress syndrome.…”

Volumetric overload shocks in the patho-aetiology of the Transurethral Resection of the Prostate (Turp) Syndrome and acute dilution hyponatraemia: The clinical evidence based on prospective clinical study of 100 consecutive Turp patients

“…He confirmed the effectiveness of hypertonic 5% NaCl or 8.4% Sodium Bicarbonate both as anecdotal evidence [42] and in a prospective study [1,2] and also investigated the underlying faulty physiological law of Starling for the capillary interstitial fluid transfer [43,44]. The results of a career life investigation which aimed at quantifying volumetric gain and its relation to the TURP syndrome highlighting VOS are now reported.…”

“…The fact that the capillary is encircled at the inlet by the pre-capillary sphincter inspired the suggestion that it may induce a Venturi effect. Further studies have revealed the totally different roles of the arterial and venous pressures in regulating simulated capillaryinterstitial fluid transfer [43,44]. In the light of these new findings, future studies are justified in order to explore the effects of volumetric overload on vascular pressures and tissue perfusion, as this may prove relevant to the pathogenesis of multiple organ failure and the adult respiratory distress syndrome.…”