Fat embolism

A fat embolism is a type of embolism that sometime caused by physical trauma.Fat embolism syndrome (FES) occurs when embolic fat macro globules pass into the small vessels of the lung and other sites, producing endothelial damage and resulting respiratory failure , cerebral dysfunction and a petechial rash.1,2 It can be difficult to diagnose.

Laboratory Tests
Laboratory tests are sometime 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 kind of test is not accurate, 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 one - two days and is attributed to intra-alveolar hemorrhage.
• Alteration in coagulation and thrombocytopenia.

We can say the diagnosis of Fat embolism syndrome may be difficult because, except for the petechiae, there are no signs which say you got fat embolism.

fat embolism treatment
One great prophylactic measure is to reduce long bone fractures as soon as possible after the injury.
Maintenance of intravascular volume is really important because shock can exacerbate the lung injury caused by Fat embolism syndrome . 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.

There is no specific therapy for fat embolism syndrome; prevention,early diagnosis, and adequate symptomatic treatment are of paramount importance. Supportive care includes maintenance of adequate oxygenation and ventilation, stable haemodynamics, blood products as clinically indicated, hydration, prophylaxis of deep venousthrombosis and stress-related gastrointestinal bleeding, and nutrition. The goals of pharmacotherapy are to reduce morbidity and prevent complications.

A high index of suspicion is needed to make the diagnosis of the often fatal fat embolism syndrome.