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Fluoride Toxicity Clinical Presentation

  • Author: Richard D Shin, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Feb 17, 2016
 

History

Determine the exact nature, amount and time of exposure or ingestion. Query patient, bystanders, paramedics, and family members regarding specifics of exposure or ingestion, including possible co-ingestants. Delayed clinical presentation of significant exposures is quite common.

Monitor and watch patients in the emergency department for 6 hours before possible discharge. Patients may be discharged if asymptomatic and ingestion was less than 3 mg/kg by accurate history. If a patient presents with persistent signs and symptoms, admit to a monitored bed.

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Physical Examination

Gastrointestinal signs and symptoms, as follows, predominate:

  • Hypersalivation
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Dysphagia
  • Mucosal injury

Neurologic effects are as follows:

  • Headache
  • Tremors
  • Muscular spasm
  • Tetanic contractions
  • Hyperactive reflexes
  • Seizures
  • Muscle weakness

Cardiovascular effects are as follows:

  • Widening of QRS
  • QTc prolongation
  • Various arrhythmias
  • Shock
  • Cardiac arrest
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Contributor Information and Disclosures
Author

Richard D Shin, MD Clinical Assistant Instructor, Resident Physician, Department of Emergency Medicine, King's County Hospital, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Acknowledgements

Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Geofrey Nochimson, MD Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

References
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  2. Samal AC, Bhattacharya P, Mallick A, Ali MM, Pyne J, Santra SC. A study to investigate fluoride contamination and fluoride exposure dose assessment in lateritic zones of West Bengal, India. Environ Sci Pollut Res Int. 2015 Apr. 22 (8):6220-9. [Medline].

  3. Qin X, Wang S, Yu M, Zhang L, Li X, Zuo Z, et al. Child skeletal fluorosis from indoor burning of coal in southwestern China. J Environ Public Health. 2009. 2009:969764. [Medline]. [Full Text].

  4. Felsenfeld AJ, Roberts MA. A report of fluorosis in the United States secondary to drinking well water. JAMA. 1991 Jan 23-30. 265(4):486-8. [Medline].

  5. Li Y, Liang C, Slemenda CW, Ji R, Sun S, Cao J, et al. Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. J Bone Miner Res. 2001 May. 16 (5):932-9. [Medline].

  6. de Cássia Alves Nunes R, Chiba FY, Pereira AG, Pereira RF, de Lima Coutinho Mattera MS, Ervolino E, et al. Effect of Sodium Fluoride on Bone Biomechanical and Histomorphometric Parameters and on Insulin Signaling and Insulin Sensitivity in Ovariectomized Rats. Biol Trace Elem Res. 2016 Feb 15. [Medline].

  7. Proudfoot AT, Bradberry SM, Vale JA. Sodium fluoroacetate poisoning. Toxicol Rev. 2006. 25 (4):213-9. [Medline].

  8. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015 Dec. 53 (10):962-1147. [Medline]. [Full Text].

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