eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Fluoride: Follow-up

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Dec 2, 2008

Follow-up

Further Inpatient Care

Further inpatient care for those with fluoride ingestion include the following:

  • Correct electrolyte abnormalities, especially hyperkalemia and hypocalcemia.
  • Hemodialysis is used for critically ill patients that are refractory to all other forms of treatment.
  • Cardiac arrhythmias are difficult to treat because they do not respond to lidocaine, cardioversion, or defibrillation.

Deterrence/Prevention

  • Keep all dangerous household products out of reach of small children.

Prognosis

  • Patients may be discharged if asymptomatic and ingestion is less than 3 mg/kg by accurate history.
  • If a patient presents with persistent signs and symptoms, admit to a monitored bed.
  • Monitor and watch patients in the ED for 6 hours before possible discharge.
  • Delayed clinical presentation of significant exposures is quite common.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to appreciate potential severity of this exposure
 


More on Toxicity, Fluoride

Overview: Toxicity, Fluoride
Differential Diagnoses & Workup: Toxicity, Fluoride
Treatment & Medication: Toxicity, Fluoride
Follow-up: Toxicity, Fluoride
References
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References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline]. [Full Text].

  2. Augenstein WL, Spoerke DG, Kulig KW, et al. Fluoride ingestion in children: a review of 87 cases. Pediatrics. Nov 1991;88(5):907-12. [Medline].

  3. Eichler HG, Lenz K, Fuhrmann M, Hruby K. Accidental ingestion of NaF tablets by children--report of a poison control center and one case. Int J Clin Pharmacol Ther Toxicol. Jul 1982;20(7):334-8. [Medline].

  4. Gessner BD, Beller M, Middaugh JP, Whitford GM. Acute fluoride poisoning from a public water system. N Engl J Med. Jan 13 1994;330(2):95-9. [Medline].

  5. Kao WF, Deng JF, Chiang SC. A simple, safe, and efficient way to treat severe fluoride poisoning--oral calcium or magnesium. J Toxicol Clin Toxicol. 2004;42(1):33-40. [Medline].

  6. Klasaer AE, Scalzo AJ, Blume C, et al. Marked hypocalcemia and ventricular fibrillation in two pediatric patients exposed to a fluoride-containing wheel cleaner. Ann Emerg Med. Dec 1996;28(6):713-8. [Medline].

  7. McIvor ME. Acute fluoride toxicity. Pathophysiology and management. Drug Saf. Mar-Apr 1990;5(2):79-85. [Medline].

  8. Schneir A, Clark RF, Kene M, Betten D. Systemic fluoride poisoning and death from inhalational exposure to sulfuryl fluoride. Clin Toxicol (Phila). Jun 16 2008;1-5. [Medline].

  9. Shulman JD, Wells LM. Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. J Public Health Dent. Summer 1997;57(3):150-8. [Medline].

  10. Vance M. Fluoride poisoning. In: The Clinical Process of Emergency Medicine. Vol 1. 1991:507-9.

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Further Reading

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Keywords

fluoride poisoning, fluoride toxicity, fluoride ingestion, toothpaste, sodium monofluorophosphate, dietary supplement, sodium fluoride, glass-etching agent, chrome-cleaning agent, ammonium bifluoride, insecticide, rodenticide 

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Contributor Information and Disclosures

Author

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.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Assistant 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.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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