Metal fume fever
Revision as of 22:48, 8 August 2025 by Benalexander (talk | contribs) (→Management: added poison control)
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.