Pharmacology Book

Miscellaneous

http://www.fpnotebook.com/

Fluoride ToxicityAka: Fluorosis

Advertisement

  1. See Also
    1. Fluoride Supplementation
  2. 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
  3. 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
  4. Toxicity
    1. Lethal dose (adults): 5-10 grams
  5. Pharmacokinetics
    1. Half-life: 2-9 hours
  6. 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)
  7. 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
  8. 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
  9. References
    1. Leiken (2001) Poisoning and Toxicology, Lexi-Comp
    2. Douglass (2004) Am Fam Physician 70:2113
    3. Woltgens (1989) Adv Dent Res 3:177

Fluoride Poisoning (C0016325)

Definition (CSP)exposure to excessive amounts of fluorine or its compounds; may occur as a result of accidental ingestion of fluoride-containing pesticides, inhalation of dusts or gases containing fluoride, or prolonged ingestion of water containing large amounts of fluorides; characterized by combined osteosclerosis and osteomalacia and mottled enamel of the teeth when exposure occurs during enamel formation.
ConceptsInjury or Poisoning (T037)
MSHD005458
EnglishChronic fluoride poisoning, Chronic fluorine poisoning, FLUORIDE INTOXICATION, FLUORIDE POIS, Fluoride Poisoning, Fluoride Poisonings, Fluorosis, POIS FLUORIDE
Spanishfluorosis, intoxicacion cronica por fluor, intoxicacion cronica por fluoruro
Parent Conceptshalogen poisoning (C0596648), Disorder of skeletal system (C0263661), Fluorine Disorders (C0549557), Bone Disorders, General and NEC (C0549572), DRUGS IN TISSUES (C0549654), Poisoning (C0032343), Bone Diseases (C0005940), Drug toxicity (C0013221), Tooth Diseases (C0040435), Pathological drug intoxication (C0152129), Toxic effect of chemical (C0520761), Chronic poisoning (C1264527), Ambiguous concept (C1274012), Chronic disease of musculoskeletal system (C1290136), Chronic digestive system disorder (C1290611)
SourcesCSP, CST, DXP, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree