Metal fume fever

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Metal fume fever
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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 (Al2O3), 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]

Contents

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 abrasive or chemical 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

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

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

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

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

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

Related Research Articles

<span class="mw-page-title-main">Cadmium</span> Chemical element with atomic number 48 (Cd)

Cadmium is a chemical element; it has symbol Cd and atomic number 48. This soft, silvery-white metal is chemically similar to the two other stable metals in group 12, zinc and mercury. Like zinc, it demonstrates oxidation state +2 in most of its compounds, and like mercury, it has a lower melting point than the transition metals in groups 3 through 11. Cadmium and its congeners in group 12 are often not considered transition metals, in that they do not have partly filled d or f electron shells in the elemental or common oxidation states. The average concentration of cadmium in Earth's crust is between 0.1 and 0.5 parts per million (ppm). It was discovered in 1817 simultaneously by Stromeyer and Hermann, both in Germany, as an impurity in zinc carbonate.

<span class="mw-page-title-main">Toxic heavy metal</span> Category of substances

A toxic heavy metal is any relatively dense metal or metalloid that is noted for its potential toxicity, especially in environmental contexts. The term has particular application to cadmium, mercury and lead, all of which appear in the World Health Organization's list of 10 chemicals of major public concern. Other examples include manganese, chromium, cobalt, nickel, copper, zinc, silver, antimony and thallium.

<span class="mw-page-title-main">Berylliosis</span> Medical condition

Berylliosis, or chronic beryllium disease (CBD), is a chronic allergic-type lung response and chronic lung disease caused by exposure to beryllium and its compounds, a form of beryllium poisoning. It is distinct from acute beryllium poisoning, which became rare following occupational exposure limits established around 1950. Berylliosis is an occupational lung disease.

<span class="mw-page-title-main">Hot-dip galvanization</span> Process of coating iron or steel with molten zinc

Hot-dip galvanization is a form of galvanization. It is the process of coating iron and steel with zinc, which alloys with the surface of the base metal when immersing the metal in a bath of molten zinc at a temperature of around 450 °C (842 °F). When exposed to the atmosphere, the pure zinc (Zn) reacts with oxygen (O2) to form zinc oxide (ZnO), which further reacts with carbon dioxide (CO2) to form zinc carbonate (ZnCO3), a usually dull grey, fairly strong material that protects the steel underneath from further corrosion in many circumstances. Galvanized steel is widely used in applications where corrosion resistance is needed without the cost of stainless steel, and is considered superior in terms of cost and life-cycle. It can be identified by the crystallization patterning on the surface (often called a "spangle").

<span class="mw-page-title-main">Brazing</span> Metal-joining technique

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<span class="mw-page-title-main">Polymer fume fever</span> Medical condition

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<span class="mw-page-title-main">Nitrogen dioxide poisoning</span> Medical condition

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<span class="mw-page-title-main">Occupational dust exposure</span> Occupational hazard in agriculture, construction, forestry, and mining

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<span class="mw-page-title-main">Detonation spraying</span> Method of thermal spraying

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<span class="mw-page-title-main">Fume extractor (soldering)</span> Soldering filter

A fume extractor is a device used to filter aerosolized chemical byproducts of the soldering process. These devices take many forms depending on the project size and application, from small ductwork to entire fume hoods. Solder itself, which is generally composed of low melting temperature metals and adjunctives, as well as the various components used during the act of soldering, including flux, rosin, and the various coatings found on solderable materials, like Polytetrafluoroethylene together present a substantial occupational health hazard. The goal of a fume extractor is to move these environmental pollutants away from the user and other occupants of the room as quickly and efficaciously as possible so as to stay within the safe exposure limits of the various substances present, and reduce the risk of adverse health outcomes like metal fume fever, polymer fume fever, occupational asthma, and allergic reaction.

References

  1. 1 2 Chastain, Steve (2004). Metal Casting: A Sand Casting Manual for the Small Foundry. Stephen Chastain. p. 8. ISBN   0-9702203-2-4.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ "Chromium and you" (PDF). Health and Safety Executive. 2013.
  5. ↑ "Welding, Cutting, Brazing | Environmental Health & Safety - The University of Alabama". ehs.ua.edu. Retrieved 2016-06-14.
  6. ↑ "Cadmium and you - working with Cadmium - are you at risk?" (PDF). Health and Safety Executive. 2010.
  7. ↑ http://www.racgp.org.au/afp/201203/201203Wong.pdf%5B%5D%5B%5D
  8. ↑ "Medline Medical Encyclopedia: Zinc"
  9. ↑ "Zinc oxide (UK PID)". inchem.org. Retrieved 2023-01-12.
  10. ↑ "Blyfri ammunisjon og helseplager - Forsvaret.no". Archived from the original on 2011-05-31. Retrieved 2011-07-05.[ full citation needed ]
  11. 1 2 3 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ "Illness caused by welding fume and gases". Health and Safety Executive (UK). Retrieved 9 May 2013.
  16. ↑ "Welding Fume Extraction". AES Industrial Supplies Limited. Retrieved 2021-04-20.
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