Fluoride Toxicity Treatment & Management
- Author: Geofrey Nochimson, MD; Chief Editor: Asim Tarabar, MD more...
Prehospital Care
Place patients with a known significant ingestion of fluoride on a cardiac monitor and initiate an IV line. Administer calcium IV to patients who present with cardiac dysrhythmias.
Emergency Department Care
- Provide cardiac monitoring.
- Hypocalcemia may be detected.
- 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 absorption of fluoride by activated charcoal. Lavage with milk or a solution containing calcium or magnesium hydroxide (eg, milk of magnesia) is theoretically attractive but has not been proven beneficial. Some recommend lavaging with 1-5% calcium chloride solution to bind fluoride in the stomach.
- Gastric aspiration and lavage are most effective when instituted within 1 hour of ingestion.
- Administer milk, calcium carbonate, and aluminum- and magnesium-based antacids (eg, hydroxides) to bind fluoride.
- Activated charcoal is not helpful. Fluoride does not bind to charcoal. Activated charcoal still is recommended for those with intentional ingestions when a polysubstance overdose is possible.
- Correct calcium deficiencies with IV calcium chloride.
Consultations
- Consult a toxicologist or poison control center for acute management recommendations.
- Psychiatric consultation is necessary after medical clearance.
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