Fluoride Toxicity Treatment & Management
- Author: Richard D Shin, MD; Chief Editor: Asim Tarabar, MD more...
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.
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