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. The diagnosis is based primarily upon a history of exposure to metal oxide fumes. When respiratory symptoms are prominent, metal fume fever may be confused with acute bronchitis or pneumonia. 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. Diagnosis ĭiagnosis is primarily anecdotal, that is, it depends upon a good occupational history. This is not an allergic reaction, though allergic reactions to metal fumes can occur. 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. 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. 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. 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. Įxposure usually arises through hot metalworking processes, such as smelting and casting of zinc alloys, welding of galvanized metals, brazing, or soldering. The effects of particularly toxic compounds, such as nickel carbonyl, are not considered merely metal fume fever. Simple metal compounds such as oxides are equally capable of causing it. Metal fume fever is due to the inhalation of certain metals, either as fine dust or most commonly as fumes. For zinc oxide, the onset of symptoms may be delayed for several hours, but typically resolve within 24 to 48 hours. 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. A sweet or metallic taste in the mouth may also be reported, along with a dry or irritated throat which may lead to hoarseness. 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. The signs and symptoms are generally flu-like. In extreme cases, cadmium (present in some older silver solder alloys) can cause loss of consciousness. Brazing and soldering can also cause metal poisoning due to exposure to lead, zinc, copper, or cadmium. Galvanized metal must be thoroughly cleaned using an angle grinder or other abrasive means to remove the galvanized coating before welding or burning. The most common form of exposure among welders occurs when welding galvanized steel, of which zinc is the primary component of the galvanization process. Welders are routinely exposed to the substances that cause metal fume fever from the base metal, plating, or filler. Other common sources are fuming silver, gold, platinum, chromium (from stainless steel), nickel, arsenic, manganese, beryllium, cadmium, cobalt, lead, selenium, and zinc. Metal fume fever, also known as brass founders' ague, brass shakes, zinc shakes, galvie flu, galvo poisoning, metal dust fever, welding shivers, or Monday morning fever, is an illness primarily caused by exposure to chemicals such as zinc oxide (ZnO), aluminium oxide (Al 2O 3), or magnesium oxide (MgO) which are produced as byproducts in the fumes that result when certain metals are heated.
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