Metal fume fever: Difference between revisions
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==Background== | ==Background== | ||
*AKA brass founders' ague, brass shakes, zinc shakes, galvie flu, metal dust fever, | *AKA brass founders' ague, brass shakes, zinc shakes, galvie flu, metal dust fever, welding shivers, Monday morning fever | ||
*Syndrome caused by inhalation of certain metals (most commonly zinc, copper, cadmium, but also aluminum, lead, nickel and various other metals<ref>https://www.twi-global.com/technical-knowledge/faqs/faq-what-is-metal-fume-fever</ref>) in form of dust or fumes, usually through hot metalworking such as welding, brazing, smelting, or soldering. | *Syndrome caused by inhalation of certain metals (most commonly zinc, copper, cadmium, but also aluminum, lead, nickel and various other metals<ref>https://www.twi-global.com/technical-knowledge/faqs/faq-what-is-metal-fume-fever</ref>) in form of dust or fumes, usually through hot metalworking such as welding, brazing, smelting, or soldering. | ||
*Thought to be due to metals stimulating cytokine release | *Thought to be due to metals stimulating cytokine release | ||
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==Clinical Features== | ==Clinical Features== | ||
*[[Flu-like illness]]; [[fever]], [[fatigue]]/malaise, [[myalgia]], [[arthralgia]], [[myalgia]], [[headache]] | *[[Flu-like illness]]; [[fever]], [[fatigue]]/malaise, [[myalgia]], [[arthralgia]], [[myalgia]], [[headache]] | ||
**Classically occurs on Monday, after reduced exposure on the weekend, and improves over the work week due to short-term tachyphylaxis | |||
**Usually resolves in 24-48h | **Usually resolves in 24-48h | ||
*+/- [[SOB]], [[chest pain]], [[pneumonitis]] | *+/- [[SOB]], [[chest pain]], [[pneumonitis]] | ||
**Rarely, severe lung injury, [[ARDS]] picture | **Rarely, severe lung injury, [[ARDS]] picture | ||
*+/- [[hypotension]], [[AMS|LOC]], [[seizure]] in severe cases | *+/- [[hypotension]], [[AMS|LOC]], [[seizure]], [[AKI]] in severe cases | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Inhalation exposure}} | |||
{{ILI DDX}} | {{ILI DDX}} | ||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
*Supportive | *Supportive | ||
*Consider consultation with [[Poison Control]] | |||
*Most cases self-limiting within 24-48h | *Most cases self-limiting within 24-48h | ||
==Disposition== | ==Disposition== | ||
*Discharge if clinically stable | *Discharge if clinically stable | ||
*Follow-up with occupational health (may require OSHA report by employer) | |||
==See Also== | ==See Also== | ||
[[Inhalation injury]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 22:48, 8 August 2025
Background
- AKA brass founders' ague, brass shakes, zinc shakes, galvie flu, metal dust fever, welding shivers, Monday morning fever
- Syndrome caused by inhalation of certain metals (most commonly zinc, copper, cadmium, but also aluminum, lead, nickel and various other metals[1]) in form of dust or fumes, usually through hot metalworking such as welding, brazing, smelting, or soldering.
- Thought to be due to metals stimulating cytokine release
Clinical Features
- Flu-like illness; fever, fatigue/malaise, myalgia, arthralgia, myalgia, headache
- Classically occurs on Monday, after reduced exposure on the weekend, and improves over the work week due to short-term tachyphylaxis
- Usually resolves in 24-48h
- +/- SOB, chest pain, pneumonitis
- Rarely, severe lung injury, ARDS picture
- +/- hypotension, LOC, seizure, AKI in severe cases
Differential Diagnosis
Inhalation injury
- Unintentional
- Smoke inhalation injury
- Chloramine
- Hydrocarbons
- Sewer gas
- Hydrazine toxicity
- Nitrogen tetroxide
- Metal fume fever
- Terrorism
- Pulmonary chemical agents
- Ammonia
- Methyl isocyanate
- methyl bromide
- Hydrochloric acid
- Chlorine
- Phosgene
- Bioterrorism
Influenza-Like Illness
- Influenza
- Parainfluenza
- URI
- Pneumonia
- Sinusitis
- Toxic exposure
- Pyelonephritis
- Bronchitis
- Coronavirus
Evaluation
- Clinical diagnosis, evaluate for alternate diagnoses
- CXR and CT chest often unremarkable in milder cases but may show ground-glass opacities or other findings[2]
- CBC- may have leukocytosis with neutrophil predominance[3]
Management
- Supportive
- Consider consultation with Poison Control
- Most cases self-limiting within 24-48h
Disposition
- Discharge if clinically stable
- Follow-up with occupational health (may require OSHA report by employer)
See Also
External Links
References
- ↑ https://www.twi-global.com/technical-knowledge/faqs/faq-what-is-metal-fume-fever
- ↑ 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.
- ↑ Kaye P, Young H, O'sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. 2002;19(3):268-9.