Fat Embolism Medication
- Author: Constantine S Bulauitan, MD; Chief Editor: Vincent Lopez Rowe, MD more...
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.
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli.
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.
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.
LR solution restores interstitial and intravascular volume. It is used in initial volume resuscitation.
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 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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