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Fluoride Toxicity Treatment & Management

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

Approach Considerations

For prehospital care, emergency medical services personnel should place patients with a known significant ingestion of fluoride on a cardiac monitor and establish intravenous (IV) access. IV calcium should be administered to patients with cardiac dysrhythmias.

In the emergency department, continue cardiac monitoring and perform an electrocardiogram. Correct electrolyte abnormalities, especially hyperkalemia, hypocalcemia, and hypomagnesemia. Correct calcium deficiencies with IV calcium chloride or calcium gluconate. Cardiac arrhythmias are difficult to treat because they do not respond to lidocaine, cardioversion, or defibrillation.

Perform gastric aspiration and lavage. Small-bore nasogastric tube aspiration, followed by lavage, is recommended because of the potential severity of this ingestion and the ineffective adsorption of fluoride to activated charcoal. Although fluoride does not bind to activated charcoal, use of activated charcoal still is recommended for patients with intentional ingestions when a polysubstance overdose is possible.

Lavage with milk or a solution containing calcium carbonate or magnesium hydroxide (eg, milk of magnesia) is theoretically attractive but has not been proven beneficial. Lavage with 1-5% calcium chloride solution has been recommended, to bind fluoride in the stomach. Gastric aspiration and lavage are most effective when instituted within 1 hour of ingestion. Hemodialysis is used for critically ill patients that are refractory to all other forms of treatment.

Consult a toxicologist or poison control center for current acute management recommendations. For intentional ingestions, consider psychiatric consultation after medical clearance.

 
 
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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