special subjects
Metal Fume Fever and Polymer Fume Fever
Symptoms and Signs
Metal fume fever typically manifests with nonspecific symptoms that mimic influenza (eg, fever, shaking chills, malaise, myalgias, arthralgias, headache). Other symptoms may include dry cough, pleuritic chest pain, shortness of breath, pharyngitis, muscle cramping, and abnormal taste sensation. Abdominal pain, nausea, and vomiting are less common. Onset of symptoms is delayed for 4 to 10 hours after exposure; symptoms may occur after the worker has completed a shift, making the association between symptoms and occupational exposure more difficult to identify. Tachyphylaxis may occur when exposure is repeated. As a result, symptoms lessen over the course of the work week but become more severe after a weekend hiatus; it is thus sometimes called Monday morning fever. Severe metal fume fever is rare and mimics Acute Hypoxemic Respiratory Failure (AHRF, ARDS) , causing fever, hypoxia, and tachypnea. Symptoms of polymer fume fever are the same as those of metal fume fever, so a history of known exposures is needed to differentiate the two syndromes. However, polymer fume fever does not cause tachyphylaxis. 