To the Editor.—
The SPECIAL COMMUNICATION by Tullis (237:355, 1977) suggested guidelines for the clinical use of albumin. The author includes deranged cardiovascular function secondary to a reduction in effective plasma volume as an indication for albumin. While it is clear that albumin will restore an effective volume more efficiently in terms of volume administered, the same end can be achieved if one gives enough crystalloid. The theoretical advantage of albumin in these situations, which has been stated by others and is implied by the author, is that administering balanced salt solutions in excess might result in fluid accumulation in the interstitial spaces of the lung because of a reduction in the colloid osmotic pressure-pulmonary capillary wedge pressure gradient (COPPCWP). This idea is based on Starling's law of fluid movement across a semipermeable membrane, which states essentially that the net movement of fluid is governed by the algebraic sum of
Buscaglia AJ. Starling's Law and Albumin Therapy. JAMA. 1977;238(9):936. doi:10.1001/jama.1977.03280100020003
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