- Metal fume fever
Metal fume fever Classification and external resources ICD-10 T59.9 ICD-9 987.8
Metal fume fever also known as brass founders' ague, brass shakes, zinc shakes, Galvie Flu, or Monday morning fever is an illness caused primarily by exposure to certain fumes. Workers breathe in fumes from chemicals such as zinc oxide (ZnO) or magnesium oxide (MgO), which are themselves created by heating or welding certain metals, particularly galvanized steel. Chromium is also a hazard, from stainless steel. Cadmium, present in some older silver solder alloys can, in extreme cases, cause loss of consciousness within a matter of minutes. Iron itself, and so most simple steels, does not give rise to it, nor does aluminium.
The symptoms are nonspecific but are generally flu-like including fever, chills, nausea, headache, fatigue, muscle aches, and joint pains. A sweet or metallic taste in the mouth which distorts the taste of food and cigarettes is also normally reported along with a dry or irritated throat which may lead to hoarseness. Symptoms may also include a burning sensation in the body, shock, no urine output, collapse, convulsions, shortness of breath, yellow eyes or yellow skin, rash, vomiting, watery or bloody diarrhea or low blood pressure, which require prompt medical attention. Milder flu-like symptoms will normally disappear within 24 to 48 hours, and someone suffering from metal fume fever will usually feel well enough to return to work the next day, despite the fact that they may still be feeling a little bit under the weather. It often takes 4 days to fully recover.
Metal fume fever is due to the inhalation of certain metals, either as fine dust or most commonly as fumes. Simple compounds of the metals, such as their oxides, are equally capable of causing it. The effects of particularly toxic compounds, such as nickel carbonyl, are not considered as a mere metal fume fever.
Exposure usually arises through hot metalworking processes, such as smelting and casting of zinc alloys, or welding of galvanized metals. If the metal concerned is particularly high-risk, then cold sanding processes may also cause it, even though the dose is lower. This may also occur with electroplated surfaces or metal-rich anti-corrosion paint, such as cadmium passivated steel or zinc chromate primer on aluminium aircraft parts. Exposure has also been reported in use of lead free ammunition, by the harder steel core stripping excess metal from the jacket of the bullet and barrel of the rifle.
The most plausible mechanism accounting for the symptoms involves an immune reaction which occurs when inhaled metal oxide fumes injure the cells lining the airways. This is thought to modify proteins in the lung. The modified proteins are then absorbed into the bloodstream, where they act as allergens.
Physical examination findings vary among persons exposed, depending largely upon the stage in the course of the syndrome during which examination occurs. Patients may present with wheezing or crackles in the lungs. They may also have an increased white blood cell count, and urine, blood plasma and skin zinc levels may (unsurprisingly) be elevated. Chest X-ray findings are generally unremarkable.
Diagnosis of metal fume fever can be difficult, as the complaints are non-specific and resemble a number of other common illnesses. When respiratory symptoms are prominent, metal fume fever may be confused with acute bronchitis. The diagnosis is based primarily upon a history of exposure to metal oxide fumes. Cain and Fletcher (2010) report a case of metal fume fever that was diagnosed only by taking a full occupational history and by close collaboration between primary and secondary health care personnel.
An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. Workers with a history of recurrent metal fume fever often develop a tolerance to the fumes. This tolerance, however, is transient, and only persists through the work week. After a weekend hiatus, the tolerance has usually disappeared. This phenomenon of tolerance is what led to the name "Monday Fever".
Treatment of mild metal fume fever consists of bedrest, and symptomatic therapy (e.g. aspirin for headaches) as indicated.
A traditional remedy is to consume large quantities of milk, either before or immediately after exposure.
Prevention of metal fume fever in workers who are at potential risk (such as welders) involves avoidance of direct contact with potentially toxic fumes, improved engineering controls (exhaust ventilation systems), personal protective equipment (respirators), and education of workers regarding the features of the syndrome itself and proactive measures which can be taken to prevent its development.
Particularly for cadmium, the design of the product may be changed so as to eliminate it. NiCd rechargeable batteries are being replaced by NiMH. Cadmium plating is replaced with zinc or nickel. Silver solder alloys now rarely contain it.
- ^ a b Chastain, Steve (2004). Metal Casting: A Sand Casting Manual for the Small Foundry. pp. 8. ISBN 0970220324. http://books.google.com/?id=BXqVDRHW-ocC&pg=PA154&lpg=PA154&dq=petrobond+bronze.
- ^ Kaye P, Young H, O'Sullivan I (May 2002). "Metal fume fever: a case report and review of the literature". Emerg Med J 19 (3): 268–9. doi:10.1136/emj.19.3.268. PMC 1725877. PMID 11971851. http://emj.bmj.com/cgi/pmidlookup?view=long&pmid=11971851.
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- ^ "Chromium and you" (pdf). HSE (UK). http://www.hse.gov.uk/pubns/indg346.pdf.
- ^ "Cadmium and you - working with Cadmium - are you at risk?" (pdf). HSE (UK). http://www.hse.gov.uk/pubns/indg391.pdf.
- ^ "Medline Medical Encyclopedia: Zinc"
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- ^ Cain, J. R.; R. M. Fletcher (2010). "Diagnosing metal fume fever - an integrated approach". Occupational Medicine (London) 60 (5): 398–400. doi:10.1093/occmed/kqq036. PMID 20407044.
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