NYC tracks and some hyperosmotic albumin thoughts.

I’m flattered and rather excited to be mentioned in the NYC tracks this week; https://thinkingcriticalcare.com/2016/08/03/the-nyc-tracks-with-jon-emile-the-glycocalyx-the-next-frontier-foamed-foamcc/

Great to hear how  others are progressing on their paths to steady state Starling enlightenment. I sometimes feel like a single voice against some of the Pharma-sponsored talking heads who sparkle on the international Congress stage and put their names to advertorials in our journals, desperately perpetuating nonsenses about biophysical osmotic “therapy”. Feedback helps me continue the resistance.

The curious ‘fact’ I wanted to raise today concerns albumin, and here it is; “Albumin has a high capacity for binding water (approximately 18 ml/g)”, right? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997295/ I have quoted this factoid myself, sure it was taught at medschool etc, but it was the great Charles Michel himself who challenged me on this. Who says? I need to find the source evidence!

As people leave the Plasma Substitute wagon, they are often drawn to the Albumin one rather than be fully liberated from the futility of biophysical osmotic ‘therapy’. Let’s for now presume there is something useful in our 18 ml / g factoid. We have a healthy patient with 150 g plasma albumin “binding” 2700 ml plasma water; A 100 ml bottle of 25% HAS has enough albumin to “bind” 450 ml water; so when we transfuse it, it binds 350 ml of the patient’s unbound intravascular water and shrinks the glycocalyx volume. (These figures are compatible with the clinical measurements Mike & Neil (Margarsson and Soni) obtained at the Westminster). Then we take into account Js for albumin; within three albumin plasma half times (less than a day in health, less than eight hours in cancer/ surgery/ sepsis etc) there will be a new ECF equilibrium; ANP response will have normalised the plasma volume and COP, the excess water and albumin will have been displaced to the interstitium. End result even in a healthy patient – raised interstitial fluid albumin and water volume. Same result in a ‘sick’ patient, just shorter time to the new equilibrium. Why would you do that?

Looking forward to conversations soon!

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