II. Symptoms and Signs
- Fluorosis (chronic exposure to >0.1 mg/kg/day)
- Tooth mottling
- Gastrointestinal effects occur at 5 mg/kg
-
Hypocalcemia
- Tetany
- Seizures
- Diminished cardiac contractility
- Ventricular Arrhythmia
- Cardiac Arrest
III. Mechanism
-
Toothpaste Overdose (children)
- Toothpaste contains 1000 ppm Fluoride
- Typical exposure: 0.27 mg/day from bid brushing
- One half tube (95 ml)
- Poison Ingestion
- Ant poison
- Roach poison
- Chronic exposure (>0.1 mg/kg/day for prolonged time)
- Items with higher fluoride concentration
- Added to drinking water at 1 ppm
- Some water contains naturally high concentrations
- Seafood contains up to 28 mg/kg
- Tea contains 0.5 mg/cup
- Total typical adult diet
- Food: <2.5 mg Fluoride
- Water: <6 mg Fluoride
- Items with higher fluoride concentration
IV. Toxicity
- Lethal dose (adults): 5-10 grams
V. Pharmacokinetics
- Half-Life: 2-9 hours
VI. Labs
- Serum Fluoride
- Normal <8 mcg/dl
- Toxic level >28 mcg/dl
-
Electrolytes
- Serum Calcium (monitor for Hypocalcemia)
- Serum Magnesium (monitor for Hypomagnesemia)
VII. Management
-
General
- Do not induce Vomiting
- Do not use Sodium Bicarbonate
- Fluoride intake <8 mg/kg
- Dilute with milk
- Fluoride intake >8 mg/kg
- Decontamination
- Gastric Decontamination (Gastric Lavage)
- Use Calcium Gluconate solution
- Consider Hemodialysis (removes 80% of body stores)
- Magnesium-based Cathartics (e.g. Milk of Magnesia)
- Gastric Decontamination (Gastric Lavage)
- Complication management
- Hypocalcemia (e.g. Tetany): Calcium Gluconate
- Ventricular Arrhythmia: Quinidine
- Decontamination
VIII. Prevention
- Keep fluoride (e.g. Toothpaste) out of child's reach
- Do not use more than pea size of toothpaste for child
- Limit bottle amount in Fluoride Supplementation
- Do not prescribe quantity >120 mg fluoride per bottle
IX. References
- Leiken (2001) Poisoning and Toxicology, Lexi-Comp
- Douglass (2004) Am Fam Physician 70:2113-22 [PubMed]
- Woltgens (1989) Adv Dent Res 3:177-82 [PubMed]