A review of the medical records of 30 patients with major trauma was undertaken. One third had fat emboli syndrome characterized by hypoxemia, confusion, and petechiae. Fluid balance was similar for all patients in the study. Hematologic indices had no prognostic value in identifying patients who were to become symptomatic from fat embolization. The serum albumin concentrations were significantly lower in the symptomatic group. The free fatty acid binding capacity of albumin is discussed.