Science commentary: Why albumin may not work

BMJ 1998;317:240 ( 25 July )

Science commentary

Why albumin may not work

The first 150 words of the full text of this article appear below.

Starling's principle is often represented as the leakage of fluids from the arterial end of capillaries, where the hydrostatic pressure is greater than the oncotic pressure (derived from theplasma proteins), and the reabsorption of fluid into the venousend, where the oncotic pressure exceeds the hydrostatic pressure.A small excess of fluid in the interstitial space $---$ when filtrationfrom the capillaries is greater than reabsorption $---$ is dealt withby lymphatic drainage from the interstitial space. The rationalefor giving albumin solutions rather than crystalloid solutionsin cases of hypovolaemic shock is that fluid reabsorption fromthe interstitial space is enhanced, and fluid therefore remainsin the vascular system for longer.

But in recent years the assumed reabsorption of fluid at the venous end of capillaries has been challenged. There is now goodevidence to show that, except in the gut and the renal circulation,there is no sustained reabsorption . . . [Full text of this article]

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