Metal fume fever is usually caused by occupational exposure to fumes that contain metal and are produced during welding and related processes. Polymer fume fever is caused by exposure to specific fluorinated polymer products, such as polytetrafluoroethylene (PTFE, known as Teflon®).
Metal fume fever usually results from inhaling zinc fumes.
Metal fume fever and polymer fume fever cause similar symptom, such as fever, chills, fatigue, muscle and joint aches, and headache.
Doctors diagnose both disorders based on exposure to the metal or polymer product fumes and the characteristic symptoms.
Measures to relieve symptoms (such as drugs to reduce fever) are usually used, but if people have difficulty breathing, mechanical ventilation may be needed.
In the 1970s, metal fume fever was fairly common among welders. Almost a third of welders aged 20 to 59 years had a least one episode during their career. Because safety regulations have improved, metal fume fever is less common today. About 1,500 to 2,500 cases occur each year in the United States. Metal fume fever may also occur in welders outside the workplace, such as artists or hobbyists who weld. Metal fume fever usually involves inhaling zinc.
Polymer fume fever causes symptoms that are similar to those of metal fume fever, but it is caused by exposure to fume produced when polytetrafluoroethylene (Teflon®) is heated to high temperatures. Exposure to PTFE fume due to overheating of Teflon® cookware in home kitchens has resulted in polymer fume fever in people and death for pet birds. Because workplace safety in the United States has improved, polymer fume fever in the workplace is less common today.
Symptoms
Metal fume fever typically causes symptoms that resemble those of influenza (such as fever, shaking chills, fatigue, muscle and joint aches, and headache). Other symptoms may include dry cough, chest pain when inhaling or exhaling, shortness of breath, a sore throat, muscle cramping, and abnormal taste sensations. Abdominal pain, nausea, and vomiting are less common.
Symptoms appear 4 to 10 hours after exposure. Symptoms may occur after the worker has completed a shift, making the connection between symptoms and exposure in the workplace more difficult to identify.
When workers are exposed to the fumes again during the work week, their symptoms may be milder, and lessen over the work week. However, symptoms become more severe after the weekend. That is why it is sometimes called Monday morning fever.
Severe metal fume fever is rare and resembles acute respiratory distress syndrome (ARDS). People with severe metal fume fever have a fever and difficulty breathing. They breathe rapidly, wheeze, and make crackling sounds when they breathe. The oxygen level in the blood is low.
Symptoms of polymer fume fever are the same as those of metal fume fever. However, symptoms of polymer fume fever do not lessen when exposure is repeated during the work week.
Diagnosis
A doctor's evaluation
Chest x-ray
To diagnose metal fume fever, doctors ask questions about possible exposure and do a physical examination, including listening to the lungs with a stethoscope. Metal fume fever is diagnosed when workers or others have been exposed to zinc fumes have the characteristic symptoms.
Chest x-rays are taken. They are typically normal in people with metal fume fever but are used to check for other possible causes of symptoms, such as pneumonia. Computed tomography (CT) of the chest is sometimes done.
Tests of lung function may be done later.
Doctors diagnose polymer fume fever based on possible exposure to heated PTFE or to overheated Teflon® cookware, followed by characteristic symptoms.
The concentration of ambient zinc and other metal fumes or polymer products is measured at different locations in the workplace to determine the extent of exposure.
Prognosis
Metal fume fever usually resolves on its own 12 to 48 hours after the last exposure to zinc or other metal fumes. However, symptoms may reappear if exposure is repeated.
Repeated exposures to metal fumes may result in chronic obstructive pulmonary disease (COPD), occupational asthma, or pulmonary fibrosis.
The prognosis for people with polymer fume fever is similar to that for people with metal fume fever.
Treatment
Measures to relieve symptoms, including drugs to reduce fever
Mechanical ventilation if needed
Treatment of metal fume fever and polymer fume fever focuses on relieving symptoms. It may include drugs to reduce fever, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Severe cases that resemble ARDS may require treatment with drugs to reduce fever and other symptoms and sometimes measures to assist in breathing (such as mechanical ventilation), for days to weeks.
People with metal or polymer fume fever are often referred to the emergency department, but most can be discharged home. Corticosteroids may be given by mouth or by vein (intravenously).
Workers with metal fume fever should be cautioned to reduce their exposure to zinc fumes by using personal protective equipment (PPE). If PPE does not adequately control exposure or if several workers are affected, the employer is contacted to implement other measures to reduce exposure.
