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August 29, 1977

Starling's Law and Albumin Therapy-Reply

JAMA. 1977;238(9):936. doi:10.1001/jama.1977.03280100020004

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The ongoing controversy over the relative merits of albumin vs large volumes of crystalloid solution as replacement for effective plasma volume has raged for many decades. Evidence can be cited by proponents of each type of solution. Indeed, the symposium which served as the basis for my communication, carefully presented both sides of this controversy.

Although Starling's law of fluid movement across a semipermeable membrane does not fit all experimental conditions, it still remains the keystone for the consideration of movement in and out of the vascular space in isolated organs or extremities. In addition to these interrelating hydrostatic and colloid osmotic pressures on the two sides of a membrane, it is necessary to invoke multiple additional forces. As clearly outlined in the review, these include tissue compliance, rates of lymph flow, changes in capillary permeability, and an intrinsic elastic recoil mechanism of connectivetissue mucopolysaccharides that exhibit inhibition