Oncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure induced by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that displaces water molecules, thus creating a relative water molecule deficit with water molecules moving back into the circulatory system within the lower pressure venous end of capillaries. It has the opposing effect of both hydrostatic blood pressure pushing water and small molecules out of the blood into the interstitial spaces within the arterial end of capillaries and interstitial colloidal osmotic pressure. These interacting factors determine the partition balancing of total body extracellular water between the blood plasma and the larger extracellular water volume outside the blood stream.
It has a major effect on the pressure across the glomerular filter. However, this concept has been strongly criticised and attention has been shifted to the impact of the intravascular glycocalyx layer as major player.
Throughout the body, dissolved compounds have an osmotic pressure. Because large plasma proteins cannot easily cross through the capillary walls, their effect on the osmotic pressure of the capillary interiors will, to some extent, balance out the tendency for fluid to leak out of the capillaries. In other words, the oncotic pressure tends to pull fluid into the capillaries. In conditions where plasma proteins are reduced, e.g. from being lost in the urine (proteinuria) or from malnutrition, there will be a reduction in oncotic pressure and an increase in filtration across the capillary, resulting in excess fluid buildup in the tissues (edema).
The large majority of oncotic pressure in capillaries is generated by the presence of high quantities of albumin, a protein that constitutes approximately 80% of the total oncotic pressure exerted by blood plasma on interstitial fluid. The total oncotic pressure of an average capillary is about 28 mmHg with albumin contributing approximately 22 mmHg of this oncotic pressure. Because blood proteins cannot escape through capillary endothelium, oncotic pressure of capillary beds tends to draw water into the vessels. It is necessary to understand the oncotic pressure as a balance; because the blood proteins reduce interior permeability, less plasma fluid can exit the vessel. 
Types of fluids
In the clinical setting, there are two types of fluids that are used for intravenous drips: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. Oncotic pressure values are approximately 290 mOsm per kg of water, which slightly differs from the osmotic pressure of the blood that has values approximating 300 mOsm /L.
- Microvascular fluid exchange and the revised Starling principle
- Choice of fluid in acute illness: what should be given? An international consensus
- Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy
- Guyton, Arthur; Hall, John (2006). "Chapter 16: The Microcirculation and the Lymphatic System". In Gruliow, Rebecca. Textbook of Medical Physiology (Book) (11th ed.). Philadelphia, Pennsylvania: Elsevier Inc. pp. 187–188. ISBN 0-7216-0240-1.
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