Starling's Principle of Fluid Exchange

In Response to Inquiries About Starling's Principle of Fluid Exchange.


LANA® is aware that for the past two decades there has been a rethinking of Starling’s Principle.  Because most references and textbooks continue to use the traditional understanding, for now Starling’s related exam questions will focus only on the traditional Starling’s forces and safety factors and their effect on fluid balance in the tissues.  Exam candidates will not be required to distinguish between “traditional” Starling’s and the more recent interpretation. 


For individuals who are interested in understanding the newer interpretation of the Starling’s Principle, the following readings are recommended.  Be aware that the content of these readings is not currently the focus of exam questions.


1.     Diseases of the Lymphatics.  Browse, Burnand, and Mortimer eds, 2003 by CRC Press, Chapter 3

2.     Levick JR: Revision of the Starling principle: new views of tissue fluid balance. J Physiol 557(3) (2004) p. 704. 2004.

3.     Levick JR, Michel CC: Microvascular fluid exchange and the revised Starling principle. Cardiovascular Research 87(2):198-210. 2010

4.     Mortimer PS, Rockson SG: New developments in clinical aspects of lymphatic disease. J. of Clinical Investigation 124(3):915-921. 2014.