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Fat Embolism Medication

  • Author: Constantine S Bulauitan, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Apr 06, 2015
 

Medication Summary

The goals of pharmacotherapy for fat embolism syndrome (FES) are to reduce morbidity and prevent complications. Corticosteroids may be used in certain cases. The best dosing protocol for corticosteroids in the prophylaxis of FES has not been established, and currently, there is no treatment regimen.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli.

Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol, A-Methapred)

 

Methylprednisolone is most often used for the prophylaxis of FES in at-risk patients. Currently, there are no good data to support the use of this agent over the use of any other steroids.

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Isotonic Crystalloids

Class Summary

Isotonic sodium chloride solution (normal saline [NS]) and lactated Ringer (LR) solution are isotonic crystalloids, the standard intravenous (IV) fluids used for initial volume resuscitation. They expand the intravascular and interstitial fluid spaces. Typically, about 30% of administered isotonic fluid stays intravascular; therefore, large quantities may be required to maintain adequate circulating volume.

Both fluids are isotonic, and they have equivalent volume-restorative properties. Whereas some differences exist between the metabolic changes observed with the administration of large quantities of one fluid and those observed with high-volume administration of the other, for practical purposes and in most situations, these differences are clinically irrelevant. No demonstrable difference in hemodynamic effect, morbidity, or mortality exists between resuscitation with NS and resuscitation with LR solution.

Normal saline (NS, 0.9% NaCl)

 

NS restores interstitial and intravascular volume. It is used in initial volume resuscitation.

Lactated Ringer

 

LR solution restores interstitial and intravascular volume. It is used in initial volume resuscitation.

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Colloids

Class Summary

Colloids are used to provide oncotic expansion of plasma volume. They expand plasma volume to a greater degree than isotonic crystalloids and reduce the tendency of pulmonary and cerebral edema. About 50% of the administered colloid stays intravascular.

Albumin (Buminate, Albuminar-5, Albuminar-25, Plasbumin-5, Plasbumin-25)

 

Albumin has been recommended for volume resuscitation. It is useful for plasma volume expansion and maintenance of cardiac output. It also binds with the fatty acids and may thus decrease the extent of lung injury. Five-percent solutions are indicated to expand plasma volume, whereas 25% solutions are indicated to raise oncotic pressure.

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Contributor Information and Disclosures
Author

Constantine S Bulauitan, MD Surgical Critical Care Fellow, Division of Acute Care Surgery, Rutgers Biomedical and Health Sciences, Rutgers Robert Wood Johnson Medical School

Constantine S Bulauitan, MD is a member of the following medical societies: American College of Surgeons, Society of Critical Care Medicine, Philippine Medical Association of America, World Surgical Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Rajan Gupta, MD, FACS, FCCP Associate Professor of Surgery, Chief, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School

Rajan Gupta, MD, FACS, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, Association for Academic Surgery, New Hampshire Medical Society, Shock Society, Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma, European Society for Trauma and Emergency Surgery, Western Trauma Association, International Society of Surgery, International Association for Trauma Surgery and Intensive Care, New England Surgical Society

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Lisa Kirkland, MD, FACP, CNSP, MSHA Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Hematoxylin-eosin stain of section of lungs showing blood vessel with fibrinoid material and optical empty space indicative of presence of lipid dissolved during staining process. This 55-year-old woman died of massive fat embolism after developing pancreatitis due to endoscopic retrograde cholangiopancreatography. Image courtesy of Wikimedia Commons. Originally published in Kanen BL, Loffeld RJLF. Pancreatitis with an unusual fatal complication following endoscopic retrograde cholangiopancreaticography: a case report. Journal of Medical Case Reports. 2008;2:215.
Frozen section of lung stained with oil red O showing multiple orange red fat globules of varying sizes in septal vasculature. Image courtesy of Dr AVC Rao, Senior Lecturer in Pathology, The University of the West Indies at St Augustine, Trinidad and Tobago. Originally published in Journal of Orthopaedics (http://www.jortho.org/2008/5/4/e8/).
 
 
 
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