Metal Fume Fever (MFF) may develop after inhalation of heavy metal oxide fumes. It may range from a relatively mild condition to one that can be fatal within a few days.
Metals associated with metal fume fever:
(1) aluminum
(2) antimony
(3) beryllium
(4) cadmium
(5) chromium
(6) cobalt
(7) copper
(8) iron
(9) lead
(10) magnesium
(11) manganese
(12) mercury
(13) nickel
(14) selenium
(15) silver
(16) vanadium
(17) zinc
Occupational exposures:
(1) military (smoke grenades or other smoke generating devices)
(2) smelting industries
General clinical signs and symptoms:
(1) fever
(2) headache
(3) sweet, metallic taste
(4) sore throat
(5) nausea with or without vomiting
(6) thirst
(7) myalgias
(8) malaise
(9) chills
(10) diaphoresis
(11) cough
(12) chest tightness
(13) dyspnea
(14) rales
(15) wheezing
(16) tachypnea
(17) tachycardia
(18) light-headedness
(19) listlessness
(20) hoarseness
(21) drunk sensation
Laboratory and physiologic measures:
(1) leukocytosis with granulocytosis
(2) elevated ESR
(3) hypoxemia
(4) reduce pulmonary function tests
(5) elevated serum LDH
Findings seen in severe metal fume fever:
(1) earlier onset of symptoms after the exposure
(2) history of significant fume exposure and/or exposure to zinc chloride
(3) cyanosis
(4) productive sputum with inflammation
(5) pulmonary edema
(6) respiratory failure
(7) abnormal chest X-ray
Clinical course for mild metal fume fever:
(1) onset of symptoms within 3-10 hours of the exposure
(2) recovery occurs 24-48 hours after the exposure
Clinical course for severe metal fume fever:
(1) The onset of symptoms within 2-4 hours of the exposure (may be as short as a few minutes).
(2) Symptoms gradually worsen over the next several hours, then remit.
(3) A relapse occurs in 24 to 48 hours with progression to respiratory failure.
(4) Fatalities tend to occur 2-5 days after the exposure.
(5) Full recovery in survivors is highly variable but may take up to 3 weeks. It may take months for pulmonary function tests and chest X-rays to return to normal.
The key diagnostic step is to identify the history of exposure to heavy metal fumes.
The key management step is not to discharge a patient too soon, especially if there has been a moderate to severe exposure.
