Objective: To demonstrate Starling’s law is wrong by summarising the substantial evidence on the hydrodynamic of the porous orifice (G) tube.
Material and methods: Focussed open mind narrative review of the substantial evidence on the hydrodynamic of the G tube that proves Starling’s law wrong is presented. It provides the replacement for explaining the capillaryinterstitial fluid transfer.
Result: The G tube has negative side pressure (SP) gradient that is maximum negative near the inlet and turns gradually positive to become maximum near the exit. Thus, in the G tube suction or absorption of fluid occurs through side holes near the inlet while filtration occurs through holes near the exit. This creates autonomous rapid dynamic magnetic field-like fluid circulation in a surrounding chamber (C) between fluid around the G tube and fluid inside its lumen. The negative SP of G tube creates net negative pressure in chamber (C) with a direction of flow opposite to that in the G tube.
Conclusion: Both physics and physiological evidence demonstrate that the capillary works as G tube in which the arterial pressure induce negative SP gradient that causes absorption by suction not filtration. Starling’s law is thus proved wrong on both forces and equation. Starling’s law being wrong has resulted in many errors and misconceptions on fluid therapy that mislead physicians into giving too much fluid during the resuscitation of shock. The resulting VO induce VO shocks (VOS): Sodium-free fluid induce VOS 1 and sodium-based fluid induce VOS 2. Examples of VOS 1 is the TUR syndrome known in urology also as hyponatremic shock. This VOS 1 is always mistaken for a known shock and is wrongly treated with further volume expansion that transfer VOS 1 into VOS 2. The later VOS 2 may also complicate fluid therapy of recognized shocks. This is in turn cause ARDS.