The toxicity of metal carbonyls is due to toxicity of carbon monoxide, the metal, and because of the volatility and instability of the complexes, any inherent toxicity of the metal is generally made much more severe due to ease of exposure. Exposure occurs by inhalation, or for liquid metal carbonyls by ingestion or due to the good fat solubility by skin resorption. Most clinical experience were gained from toxicological poisoning with nickel tetracarbonyl and iron pentacarbonyl due to their use in industry. Nickel tetracarbonyl is considered as one of the strongest inhalation poisons.
Inhalation of nickel tetracarbonyl causes acute non-specific symptoms similar to a carbon monoxide poisoning, such as nausea, cough, headache, fever, and dizziness. After some time, severe pulmonary symptoms such as cough, tachycardia, and cyanosis, or problems in the gastrointestinal tract occur. In addition to pathological alterations of the lung, such as by metalation of the alveoli, damages are observed in the brain, liver, kidneys, adrenal glands, and spleen. A metal carbonyl poisoning often necessitates a lengthy recovery.
Chronic exposure by inhalation of low concentrations of nickel tetracarbonyl can cause neurological symptoms such as insomnia, headaches, dizziness and memory loss. Nickel tetracarbonyl is considered carcinogenic, but it can take 20 to 30 years from the start of exposure to the clinical manifestation of cancer.