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I started this website when I retired, now in its seventh year and below are the stats for 2021, a fairly typical year. My mission has been to teach the basics of fluid physiology to clinical prescribers, and to provide impartial opinions on the various flavours of intravenous therapies available

While I welcome an upturn in clinician interest in the lymphatic system, I still see accounts of lymphatic/ interstitial fluid circulation that ignore the absorption of fluid into lymph node venules. I have previously pointed to the work of Dr Corinne Becker at the Lymphoedema Centre,. Students of the steady

My Christmas Blog 2021 looks at the fluid physiology of nanobubbles. Clinicians are comfortable with solution of gas molecules in aqueous solutions. We measure the partial pressures of vital gases in blood very frequently, and understand that greater pressure means more molecules (of O2, CO2 etc) per unit volume. We

This week I received an email from friend & colleague William (Bill) Muir in the USA. He shared some papers for me to comment on, and they have led me through some very interesting observations about the current state of sciences and their divergence. Time was that medicine and physiology

The recent publication by Löffel et al1 concerning the Starling principle reveals some important misunderstandings common amongst clinicians about the science. The Authors confuse the Frank Starling Law (of the heart) with Starling’s principle of fluid exchange, often expressed as the Starling equation which I explain here. Jv is the

The traditional paradigm of lecture theatre gatherings, authoritative Textbooks, accredited congresses and conferences has rapidly dwindled. Today people are choosing Twitter Experts, non-peer reviewed electronic publications, and on-line Presentations without live interactions. Love it or loathe it, there is no going back. Fake News communications are increasingly succeeding in getting

The Intensive Care Society’s Webinar on Fluids yesterday was Sold Out with record number of delegates and is receiving rave reviews. Ashley Miller’s drawing of the J curve “explains it all as you’ve never seeen it” @PARADicmSHIFT. I reproduce it below. My first attempt at the J curve looked like

The American Journal of Pathology Special edition opens with an overview of nanomechanics; the connections between the luminal surface endothelial glycocalyx and the intra-endothelial cortex, largely composed of actin molecules, is emphasised. The sequelae of endothelial glycocalyx injury include enhanced vascular permeability, tissue oedema, augmented leukocyte adhesion, platelet aggregation, and

A beautifully illustrated report on the cerebral microcirculation of mice provides many answers to the role of precapillary sphincters in cerebral perfusion autoregulation. Grubb, S., Cai, C., Hald, B.O. et al. Precapillary sphincters maintain perfusion in the cerebral cortex. Nat Commun 11, 395 (2020). In previous blogs we considered the

Original Starling principle paradigm Extended Starling principle or Glycocalyx Model paradigm. Intravascular volume consists of plasma and cellular elements. Intravascular volume consists of glycocalyx volume, plasma volume, and cellular elements. Capillaries separate plasma with high protein concentration from interstitial fluid (ISF) with low protein concentration.  Sinusoidal tissues (marrow, spleen, and