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Chapter: Modern Medical Toxicology: Chemical Poisons: Heavy Metals

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Metal Fume Fever - Chemical Poisons

Brass chills; Brass founder’s ague; Brazier disease; Copper colic; Foundry fever; Galvanised shakes; “Galvo”; Metal ague; Metal shakes; Monday fever; The shakes; The smothers; Smelter shakes; Welder’s ague; Zinc chills.

Metal Fume Fever

Synonyms

Brass chills; Brass founder’s ague; Brazier disease; Copper colic; Foundry fever; Galvanised shakes; “Galvo”; Metal ague; Metal shakes; Monday fever; The shakes; The smothers; Smelter shakes; Welder’s ague; Zinc chills.

Occupations Affected

Welding, galvanising, smelting, metal refining, electroplating, metal polishing, metallic pigment manufacture, alloy making, ship breaking, etc.

Metals Involved

The syndrome is caused by inhalation of fumes produced when the following metals are heated above their melting point (indecreasing order of importance): zinc, copper, magnesium,iron, chromium, cadmium, nickel, manganese, mercury, cobalt, lead, antimony, selenium, beryllium, vanadium, silver, and aluminium.

Clinical Features

·      The syndrome resembles a flu-like illness, beginning 4 to 6 hours after exposure to fumes, and is characterised by chills, fever, myalgia, cough, dyspnoea, fatigue, metallic taste, salivation, thirst, sweating, tachycardia, tachypnoea, leukocytosis, cyanosis, and reduced pulmonary function tests. The chest x-ray may be clear.

·      Resolution of symptoms occurs 36 hours after stoppage of exposure, so that over the weekend usually the worker becomes allright only to succumb once again the following Monday (Monday fever).

·      Sequelae are uncommon. Pulmonary lesions and residual effects are extremely rare and are not generally considered classical signs of metal fume fever. However, exposure to chromium and nickel fumes has resulted in increased inci-dence of lung cancer.

Diagnosis

Heavy metal screens or specific metal assay may be necessary to identify a causal agent in patients with significant acute or chronic toxicity.

Treatment

·      Symptomatic and non-specific. Chelation therapy may be required.

·      Corticosteroids have occasionally been recommended to reduce inflammatory response in patients with serious pulmonary involvement. Recommended regimen: 60 mg of prednisone per day, which is then tapered over the next week, or single dose of methylprednisolone 250 to 500 mg IV. Controlled studies demonstrating the benefits of corticosteroids have not been performed.

·      Analgesics and antipyretics should be administered as necessary.

·              Prophylactic antibiotics are not generally recommended unless bacterial infection is suspected.

·      Specific antidotal therapy may be indicated for symptomatic toxic metal inhalation.

Prevention

■■  Implementation of engineering controls.

■■  General room ventilation.

■■  Local exhaust ventilation.

■■  Process enclosure.

■■  Down-draft or cross-draft tables.

■■  Use of fume extractors.

Related Syndromes

A condition very closely resembling metal fume fever called polymer fume fever results from inhalation of gases producedby burning of polytetrafluoroethylene (Teflon). It is similar in presentation to metal fume fever, with short-term, flu-like symptoms of sore throat, fever, shivering, and weakness. Symptoms are usually less severe than with metal fume fever and require only symptomatic treatment.

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