found a pearl.

I think the modern phrase is “I need to get my head around [insert here]”, and I fully accept that the glycocalyx model (Michel-Weinbaum model) is one concept it is hard to get your head around. Unfortunately you can’t be a rational prescriber of fluids if you haven’t got your head round the steady state Starling principle and its clinical corollaries. I am always on the lookout for a different perspective which just might help and I found one today. Published by Edward Crockett of Alabama in a very specialist journal, it gives an eloquent history and plenty of references.

“fluid filtration is always maintained in a steady state condition rather than reabsorbed at lower pressures, [and ] the interstitial protein concentration does not affect the filtration rate. These two major diversions from the original Starling Principle make enormous contributions in our understanding of edema, but as of yet they are not a part of mainstream education.”


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