Overview
Fat Embolism Syndrome follows long bone fractures. Its classic presentation consists of an asymptomatic interval followed by pulmonary and neurologic manifestations combined with petechial hemorrhages. The syndrome follows a biphasic clinical course. The initial symptoms are probably caused by mechanical occlusion of multiple blood vessels with fat globules that are too large to pass through the capillaries. Unlike other embolic events, the vascular occlusion in fat embolism is often temporary or incomplete since fat globules do not completely obstruct capillary blood flow because of their fluidity and deformability. The late presentation is thought to be a result of hydrolysis of the fat to more irritating free fatty acids which then migrate to other organs via the systemic circulation.
Laboratory Tests
Laboratory tests are mostly nonspecific:
- Serum lipase level increases in bone trauma - often misleading.
- Cytologic examination of urine, blood and sputum with Sudan or oil red O staining may detect fat globules that are either free or in macrophages. This test is not sensitive, however, and does not rule out fat embolism.
- Blood lipid level is not helpful for diagnosis because circulating fat levels do not correlate with the severity of the syndrome.
- Decreased hematocrit occurs within 24-48 hours and is attributed to intra-alveolar hemorrhage.
- Alteration in coagulation and thrombocytopenia.
Treatment
The most effective prophylactic measure is to reduce long bone fractures as soon as possible after the injury.
Maintenance of intravascular volume is important because shock can exacerbate the lung injury caused by FES. Albumin has been recommended for volume resuscitation in addition to balanced electrolyte solution, because it not only restores blood volume but also binds fatty acids, and may decrease the extent of lung injury.
Mechanical ventilation and PEEP may be required to maintain arterial oxygenation.
High dose corticosteroids have been effective in preventing development of FES in several trials, but controversy on this issue still persists.
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