Minerals

Fluoride Toxicity

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Fluoride Toxicity, Fluorosis, Fluoride Increased, Fluoride Poisoning

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