Medical condition
Metal fume fever
, also known as
brass founders' ague
,
brass shakes
,
[1]
zinc shakes
,
galvie flu
,
galvo poisoning
,
metal dust fever
,
welding shivers
, or
Monday morning fever
,
[2]
is an illness primarily caused by exposure to chemicals such as
zinc oxide
(ZnO),
aluminium oxide
(Al
2
O
3
), or
magnesium oxide
(MgO) which are produced as byproducts in the fumes that result when certain metals are heated. Other common sources are fuming
silver
,
gold
,
platinum
,
[3]
and
chromium
.
[4]
Welders
are routinely exposed to fumes. The most common form of exposure among welders occurs when
welding
galvanized steel, of which
zinc
is the primary component of the
galvanization
process. Galvanized metal must be thoroughly cleaned using an angle grinder or other abrasive means to remove the galvanized coating before welding or burning.
Brazing
and
soldering
can also cause metal poisoning due to exposure to lead, zinc,
copper
, or
cadmium
.
[5]
In extreme cases, cadmium
[6]
(present in some older
silver solder
alloys) can cause loss of consciousness.
Signs and symptoms
[
edit
]
The signs and symptoms are generally
flu-like
. They include
fever
,
chills
,
nausea
,
headache
,
fatigue
,
muscle aches
,
joint pains
, lack of appetite,
shortness of breath
,
pneumonia
, chest pain, change in blood pressure, dizziness, and coughing. A sweet or metallic taste in the mouth may also be reported, along with a dry or irritated throat which may lead to hoarseness.
[7]
Symptoms of a more severe metal toxicity 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 or
high blood pressure
, which require prompt medical attention.
[8]
For zinc oxide, the onset of symptoms may be delayed for several hours, but typically resolve within 24 to 48 hours.
[9]
Cause
[
edit
]
Exposure usually arises through hot metalworking processes, such as smelting and casting of zinc alloys, welding of galvanized metals, brazing, or soldering. If the metal concerned is particularly high-risk, the residue from cold sanding processes may also cause fume fever, even if the dose is lower. It may also be caused by 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 metal from the jacket of the bullet and barrel of the rifle.
[10]
The most plausible metabolic source of the symptoms is a dose-dependent release of certain
cytokines
, an event which occurs by inhaling metal oxide fumes that injure the lung cells. This is not an allergic reaction, though allergic reactions to metal fumes can occur.
[11]
Diagnosis
[
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]
Diagnosis is primarily anecdotal, that is, it depends upon a good occupational history. Diagnosis of metal fume fever can be easily missed because the complaints are non-specific, resemble a number of other common illnesses, and presentation occurs typically 2?10 hours after the exposure.
[12]
When respiratory symptoms are prominent, metal fume fever may be confused with acute
bronchitis
or pneumonia. 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.
[13]
Physical symptoms 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 typically have an increased white blood cell count, and urine, blood plasma and skin zinc levels may be elevated. Chest X-ray abnormalities may also be present.
[11]
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".
[
citation needed
]
In 2018, there were 259 cases of metal fume fever reported to the United States
Poison Control Center
.
[14]
Treatment
[
edit
]
Treatment of mild metal fume fever consists of bedrest, keeping the patient well hydrated, and symptomatic therapy (e.g.
aspirin
for headaches) as indicated. In the case of non-allergic
acute lung injury
, standard or recommended approaches to treatment have not been defined.
[11]
The consumption of large quantities of
cow's milk
, either before or immediately after exposure is a traditional remedy.
[1]
However, the United Kingdom Health and Safety Executive challenges this advice, warning, "Don't believe the stories about drinking milk before welding. It does not prevent you getting metal fume fever."
[15]
Prevention
[
edit
]
Prevention of metal fume fever in workers who are at 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 to prevent its development.
[16]
In some cases, the product's design may be changed so as to eliminate the use of risky metals. Cadmium is often replaced by other metals.
NiCd
rechargeable batteries are being replaced by
NiMH
. These contain other toxic metals, such as chromium,
vanadium
and
cerium
. Zinc or nickel plating can be used instead of cadmium plating, and brazing filler alloys now rarely contain cadmium.
[
citation needed
]
See also
[
edit
]
References
[
edit
]
- ^
a
b
Chastain, Steve (2004).
Metal Casting: A Sand Casting Manual for the Small Foundry
. Stephen Chastain. p. 8.
ISBN
0-9702203-2-4
.
- ^
Kaye, P; Young, H; O'Sullivan, I (2002).
"Metal fume fever: A case report and review of the literature"
.
Emergency Medicine Journal
.
19
(3): 268?9.
doi
:
10.1136/emj.19.3.268
.
PMC
1725877
.
PMID
11971851
.
- ^
El-Zein, M; Malo, J. L; Infante-Rivard, C; Gautrin, D (2003).
"Prevalence and association of welding related systemic and respiratory symptoms in welders"
.
Occupational and Environmental Medicine
.
60
(9): 655?61.
doi
:
10.1136/oem.60.9.655
.
PMC
1740619
.
PMID
12937186
.
- ^
"Chromium and you"
(PDF)
. Health and Safety Executive. 2013.
- ^
"Welding, Cutting, Brazing | Environmental Health & Safety - The University of Alabama"
.
ehs.ua.edu
. Retrieved
2016-06-14
.
- ^
"Cadmium and you - working with Cadmium - are you at risk?"
(PDF)
.
Health and Safety Executive
. 2010.
- ^
http://www.racgp.org.au/afp/201203/201203Wong.pdf
[
dead link
]
[
full citation needed
]
- ^
"Medline Medical Encyclopedia: Zinc"
- ^
"Zinc oxide (UK PID)"
.
inchem.org
. Retrieved
2023-01-12
.
- ^
"Blyfri ammunisjon og helseplager - Forsvaret.no"
. Archived from
the original
on 2011-05-31
. Retrieved
2011-07-05
.
[
full citation needed
]
- ^
a
b
c
Kunimasa, Kei; Arita, Machiko; Tachibana, Hiromasa; Tsubouchi, Kazuya; Konishi, Satoshi; Korogi, Yohei; Nishiyama, Akihiro; Ishida, Tadashi (2011).
"Chemical Pneumonitis and Acute Lung Injury Caused by Inhalation of Nickel Fumes"
.
Internal Medicine
.
50
(18): 2035?8.
doi
:
10.2169/internalmedicine.50.5557
.
PMID
21921392
.
- ^
Greenberg, Michael I; Vearrier, David (2015). "Metal fume fever and polymer fume fever".
Clinical Toxicology
.
53
(4): 195?203.
doi
:
10.3109/15563650.2015.1013548
.
PMID
25706449
.
S2CID
21977121
.
- ^
Cain, J. R; Fletcher, R. M (2010).
"Diagnosing metal fume fever--an integrated approach"
.
Occupational Medicine
.
60
(5): 398?400.
doi
:
10.1093/occmed/kqq036
.
PMID
20407044
.
- ^
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, Hashem HA, Ryan ML (2019-11-21).
"2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report"
(PDF)
.
Clinical Toxicology
.
57
(12): 1220?1413.
doi
:
10.1080/15563650.2019.1677022
.
PMID
31752545
.
S2CID
208227320
. Retrieved
2020-04-03
.
- ^
"Illness caused by welding fume and gases"
. Health and Safety Executive (UK)
. Retrieved
9 May
2013
.
- ^
"Welding Fume Extraction"
.
AES Industrial Supplies Limited
. Retrieved
2021-04-20
.
External links
[
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]