II. 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

III. 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

IV. Toxicity

  1. Lethal dose (adults): 5-10 grams

V. Pharmacokinetics

  1. Half-life: 2-9 hours

VI. 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)

VII. 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

VIII. 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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: 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.
Concepts Injury or Poisoning (T037)
MSH D005458
SnomedCT 12395005, 244183009
English Fluoride Poisonings, Poisoning, Fluoride, Poisonings, Fluoride, Fluoride Poisoning, FLUORIDE POIS, POIS FLUORIDE, Fluoride intoxication, Fluoride Poisoning [Disease/Finding], fluorosis, Chronic fluoride poisoning (disorder), Fluorosis, Chronic fluoride poisoning, Fluorosis (disorder), Chronic fluoride poisoning (disorder) [Ambiguous]
Italian Fluorosi, Intossicazione da fluoruro, Avvelenamento da fluoruri
Dutch fluoride-intoxicatie, fluorose, Fluoridevergiftiging, Vergiftiging, fluoride-
German Fluoridintoxikation, Fluorose, Fluoridvergiftung
Portuguese Intoxicação por fluoreto, Intoxicação por Fluoreto, Envenenamento por Fluoreto, Envenenamento por Fluor, Fluorose, Intoxicação por Flúor
Spanish Intoxicación por fluor, intoxicación crónica por fluoruro, intoxicación crónica por fluoruro (trastorno), Enveneamiento por Fluoruro, Intoxicación por Fluoruro, Envenenamiento por Flúor, fluorosis (trastorno), fluorosis, intoxicación crónica por fluoruro (concepto no activo), intoxicación crónica por flúor, Fluorosis, Intoxicación por Flúor
Japanese フッ素症, フッ素中毒, フッソチュウドク, フッソショウ, 中毒-フッ化物, フッ化物中毒, ふっ化物中毒, 弗化物中毒, フッ素化合物中毒, 弗素化合物中毒
Swedish Fluoridförgiftning
Czech fluoridy - otrava, Fluoróza, Fluoridová intoxikace
Finnish Fluoridimyrkytys
Russian FTORISTYMI SOEDINENIIAMI OTRAVLENIE, ФТОРИСТЫМИ СОЕДИНЕНИЯМИ ОТРАВЛЕНИЕ
Croatian FLUORIDI, TROVANJE, TROVANJE FLUORIDIMA
Polish Zatrucie fluorkami
Hungarian Fluorid intoxicatio, Fluorosis
Norwegian Fluoridforgiftning
French Fluorose, Inoxication fluorée, Intoxication au fluorure, Intoxication au fluor

Ontology: Fluoride increased (C0852203)

Concepts Finding (T033)
Dutch fluoride verhoogd
French Fluorure augmenté
German Fluorid erhoeht
Italian Fluoruro aumentato
Portuguese Floretos aumentados
Spanish Fluoruro elevado
Japanese フッ化物増加, フッカブツゾウカ
Czech Zvýšení fluoridů
Hungarian Fluorid emelkedett
English Fluoride increased