Fat Embolism and the Adult Respiratory Distress Syndrome

Fat embolism in infancy after intravenous fat infusions.

“…Weisz et al (1974) list ten minor signs on which to base a diagnosis, keeping in mind children on long-term Intralipid infusion: hypoxia, pyrexia; tachycardia; anaemia; thrombocytopenia (with or without coagulopathy); petechiae; fat excretion in urine or sputum; changes in fat metabolism (fat macroglobulinaemia, raised serum lipase, lipid electrophoretic changes); 'snowstorm' chest x-ray and neurological abnormalities such as paresis, coma, and electroencephalographic changes. Hypoxaemia is an early sign and the similarity to idiopathic respiratory distress syndrome is well recognised (Ashbaugh et al, 1967;Burgher et al, 1974). Diagnosis of fat embolism can only be made with certainty during life by the detection of retinal fat embolism or from biopsy.…”

Pulmonary Complications of Sickle Cell Disease

“…The FES in SCD, as in trauma (Table 3), has features that resemble pulmonary infection. 48 * Reproduced with permission from Burgher et al 48 However, severe bone pain and thrombocytopenia may provide diagnostic clues to its presence. 49 ' 50 Recent data from a careful study of the ACS noted a decrease in hematocrit and platelet count in the more severe cases and significant thrombocytopenia in two fatalities.…”

Embolia gordurosa: uma revisão para a prática ortopédica atual

“…In fact, it is not uncommon to find laboratorial changes compatible to DIVC syndrome in some cases of FES (22,27,45,74) , yet the occurrence of the hemorrhagic syndrome secondary to this consuming coagulopathy is extremely rare (13) . On the other hand, there are well established FES case series, in which the authors did not manage to detect laboratory changes characterizing DIVC in none of the patients (30,75) . For the great majority of researchers, therefore, DIVC is considered as an infrequent phenomenon, which can or cannot occur in conjunction with FES (13,27,74,76) .…”

“…During prosthesis cementation, IMP can reach values of 650 to 1500 mmHg (7)(8)(9) and the embolization may last for more than 20 min (5,6,15,33) . Although, fortunately, the vast majority of those patients do not really develop acute 'cor-pulmonale' during the most intense phase of the FE, they always present deep hemodynamic and respiratory changes during this period, such as: severe arterial hypertension, cardiac arrhythmia, increased pulmonary artery pressure and pulmonary vascular resistance, pulmonary arterial-venous shunt increase, and, consequently, a reduction on PaO2 (6,7,9,15,17,30,99) . Those effects may last just for a few minutes, or may remain for many hours post-operatively (5)(6)(7)55,58) .…”

“…As lungs and brain are the visci mostly affected, the main clinical manifestations are the acute respiratory failure (with characteristics of the Adult Respiratory Distress Syndrome -ARDS) and cerebral damage, which may range from a simple anxiety to irreversible coma and death (28) . FES is a relatively rare, but extremely severe condition, with mortality rates ranging from 10 to 36% (18,(29)(30)(31)(32) , most of the cases occurring in orthopaedic patients (8,16,20,22,24,32) .…”