What is Metal Fume Fever (Monday Morning Fever)?
Metal fume fever is a brief illness that causes fever-like symptoms, typically occurring in individuals who work with metals, such as welders. Welding involves tasks like filling gaps and smoothing surfaces in the metal. After engaging in activities where metals are fused together, individuals may develop flu-like symptoms. These symptoms can get better during the work week, but they return if the individual is exposed again when they go back to work, which is why it is sometimes referred to as “Monday morning fever”. The existence of this sickness was first recorded back in the 1830s. The confirmation that metal oxides cause fever, breathing trouble, and muscle aches occurred when Lehmann and four volunteers exposed themselves to gases product of the welding process, such as zinc oxide.
The Bureau of Labor Statistics has found that metal fume fever is most commonly seen in individuals who work as welders, cutters, brazers, and solderers. Welders often use electric currents that create a lot of heat to slightly melt metals and bind them together. Arc welding uses intense heat to melt metals and allow bonding. The type of process used depends on the type of metals being worked on, with zinc being the metal most often involved.
“Cutters” use a highly-charged gas called plasma to cut metal objects into specific shapes. This is often used when taking apart large objects such as ships, buildings or railroad cars. Solderers and brazers use a third metal to join two or more other metal objects. Solderers often work with small pieces of metal that need careful placement, like transistors or computer chips. Brazers fuse different types of metals together using filler material, creating strong connections. Brazing can also provide protection against wear and tear and corrosion.
Health problems from exposure to metal fumes have been recognized for approximately 200 years, with several names used to describe the condition, such as Monday fever, brass founders’ ague, welders’ ague, smelter chills, and zinc shakes. This is usually caused by inhaling fumes when welding or cutting galvanized metal, a process where a zinc coating is applied to steel to protect it from corrosion and weakening.
What Causes Metal Fume Fever (Monday Morning Fever)?
Welding involves heating metals to very high temperatures causing them to release vapors. These vapors then cool down, react with air (oxidize), and can be breathed in by the welder. The metals involved can include zinc, iron, cadmium, manganese, chromium, and nickel. It’s been observed that about 30% of welders in their middle age have experienced this at least once during their careers. The main reason behind this is zinc oxide, which is produced when working with molten bronze or galvanized steel.
Risk Factors and Frequency for Metal Fume Fever (Monday Morning Fever)
According to 2020 data from the Bureau of Labor Statistics, over 420,000 people in the United States were involved in jobs that deal with metals. It is estimated that out of these, around 2000 cases of a condition known as metal fume fever were reported. This condition even affects those who don’t work with metals full time, including plumbers, pipe fitters, artists, and people who occasionally do metal works at home.
- Most of these cases, about 96%, occur in men.
- The disease often follows a pattern with symptoms showing up at the start of the working week, typically on Mondays and Tuesdays, and disappearing on days off work like Sundays.
- Data from the Louisiana Poison Control Center showed that out of 26 reported cases over two years, 75% of the people did not seek further medical care beyond reporting.
- Only four were evaluated in an emergency department, and just one person was admitted to the hospital.
Signs and Symptoms of Metal Fume Fever (Monday Morning Fever)
Most people experience mild symptoms when exposed to metal binding fumes. These symptoms usually appear similar to the flu, manifested with fever, body aches, joint pain, headache, wheezing, extreme thirst, and a metallic taste in the mouth. These symptoms generally occur between 4 to 10 hours after the exposure stops.
Typically, results from a pulse oximeter, a device that measures oxygen levels in your blood, are normal. The symptoms usually peak at 18 hours and generally go away within 24 to 48 hours. However, in rare cases, individuals might experience severe conditions like lung inflammation, acute respiratory distress syndrome, inflammation of the tissue around the heart, and a non-infectious form of meningitis.
- Fever
- Body aches
- Joint pain
- Headache
- Wheezing
- Extreme thirst
- Metallic taste in the mouth
- Symptoms peak at 18 hours
- Symptoms usually disappear within 24 to 48 hours
Testing for Metal Fume Fever (Monday Morning Fever)
When assessing patients, finding out about their work or hobbies is very important. Common questions include whether they smoke, drink alcohol, or use drugs. But understanding how someone spends their day, whether at work or during their hobbies, can be crucial. For example, if someone is a welder, it can be a clue towards diagnosing a condition called metal fume fever.
If a health care provider does not ask about someone’s job or hobbies, they could miss this diagnosis. This could lead to a person continuing to expose themselves to unsafe conditions without proper protection, like a mask or adequate ventilation, and working long hours.
Tests like checking for changes in chemical properties in the blood, blood clotting, and taking a chest X-ray are usually normal or show no change from what is usual for the patient. There might be a small increase in a type of white blood cells, which is a common response to infection or inflammation.
C-reactive protein, a substance produced by the liver in response to inflammation, might be elevated in a patient’s blood test, but this isn’t specific to metal fume fever. Generally, further tests aren’t needed unless another health issue is suspected. If someone is exposed to zinc oxide during welding, they might have an increase in a type of white blood cells in their lung fluid, but it wouldn’t change lung function. Sometimes in more severe cases, there can be inflammation in the lungs or even a severe lung condition called acute respiratory distress syndrome.
Treatment Options for Metal Fume Fever (Monday Morning Fever)
This illness is often mild and tends to get better on its own. The main focus of treatment is on relieving the symptoms. Medications that reduce fever (antipyretics) can be used for fever, and patients may be given fluids if they’re dehydrated. In some cases, extra oxygen is given for a condition called hypoxemia, which means there’s not enough oxygen in the blood.
If the patient has difficulty breathing due to constricting airways (bronchospasm), medications like inhaled beta-agonists and a type of anti-inflammatory medication called glucocorticoids can be of help.
In rare cases, if the person develops inflammation in the lungs (pneumonitis) – often linked to exposure to a metal called cadmium – a chest X-ray can be beneficial to understand the situation better.
What else can Metal Fume Fever (Monday Morning Fever) be?
The sharp doctor will realize the connection between a person’s job, their exposure to certain things, and the symptoms they’re experiencing in the case of metal fume fever. There are several other conditions that might also be considered while diagnosing the disease:
- Pneumonia caused by Cadmium
- Covid-19
- Flu (Influenza)
- Infections caused by Hemophilus influenza bacteria
- Parainfluenza (a viral respiratory infection)
- Polymer fume fever (a condition similar to metal fume fever but caused by the inhalation of certain plastic fumes)
- Respiratory syncytial virus, a common virus that leads to mild, cold-like symptoms
- General viral sickness
- Pneumonia caused by a virus
What to expect with Metal Fume Fever (Monday Morning Fever)
This condition is usually not serious and often resolves within half a day to two days. If you continue to be exposed to the source of the illness, the symptoms can become cyclical. This means they might improve on Sunday but worsen significantly on Mondays and Tuesdays.
As people age, their lung function typically declines. However, this decline is more noticeable in people who are metal fume welders compared to the average person.
Possible Complications When Diagnosed with Metal Fume Fever (Monday Morning Fever)
In extreme cases of hypersensitivity pneumonitis, two procedures might be thought about. These are a treatment using a medical device to help with breathing called bilevel-positive airway pressure (BiPAP) and a procedure to insert a tube into the windpipe called endotracheal intubation.
Preventing Metal Fume Fever (Monday Morning Fever)
It’s essential for health and safety experts to evaluate workplace conditions, especially if it involves risky procedures like welding. Workers should try to keep their heads and faces away from harmful fumes and avoid breathing them in. To make the environment safer, it may be necessary to enhance airflow and secure enough exhaust at the work site. Protective attire such as masks and suitable work clothes are needed.
Education about safety measures is a must in places where welding is done. In America, workers can request a Health Hazard Evaluation that involves the National Institute of Occupational Safety and Health (NIOSH). This could even include a visit to their workplace. As a minimum safeguard, welders usually wear N95 masks. However, they’re not as protective as half-face masks, full-face respirators, or powered air-purifying respirators.
NIOSH has set safety standards for workplaces. They suggest that workers should not be exposed to more than 5 milligrams of hazardous substances per cubic meter of air over a 10-hour work shift in a 40-hour work week. For shorter exposures of 15 minutes, the maximum safe level is 10 milligrams per cubic meter.
