Acute Fluoride Toxicity – Risk Doses, Symptoms, Management

Fluorides are one of the most important components for the development of teeth and the hard tissues of the body. But the amount of Fluorides that has to be given to people, should be in a certain limit, crossing which could pose several problems and lead to toxicity. The fluoride toxicity is divided into acute and chronic toxicity, the acute toxicity being a severe and faster affecting one. Acute Fluoride Toxicity results from excessive ingestion of Fluoride at one time. The speed and the severity of the response are dependent on amount of Fluoride ingested and weight and age of the individual.

Fluoride Doses:

• Safe Tolerated Dose – 8mg to 16mg/Kg Body Weight.
• Toxic Dose – 16mg to 32mg/Kg Body Weight.
• Lethal Dose – 32mg to 64mg/Kg Body Weight.
• In Acute Poisoning Fluoride causes death by blocking normal cellular metabolism.
• Death usually results from either Cardiac Failure (or) Respiratory Paralysis.

Signs and Symptoms:

• Nausea, Vomiting
• Abdominal Pain, Diarrhea
• Excess Salivation and Mucosal Discharge
• Generalized Weakness and Carpopedal Spasms
• Weak Thready Pulse, Fall in Blood Pressure
• Depression of Respiratory Center
• Decreased Plasma Calcium Level, Increased Plasma Potassium Level
• Cardiac Arrhythmia
• Coma and Death

Management of Acute Fluoride Toxicity:

Less than 5mg/Kg:

i. Give Calcium orally to relieve Gastro Intestinal symptoms and observe for few hours.
ii. Induce Vomiting

More than 5mg/Kg But Less Than 15mg/Kg Body Weight:

i. Empty the Stomach by inducing vomiting with Emetics

For patient with depressed “Gag Reflex” Induced Vomiting is Contraindicated and Endotracheal Intubation should be performed before Gastric Lavage.

i. Give orally soluble calcium in any form.
ii. Admit to Hospital and observe for few hours.

More than 15mg/Kg:

i. Admit to Hospital immediately.
ii. Induce Vomiting
iii. Begin Cardiac Monitoring
iv. Slow administer Intravenous 10% Ca+ Gluconate Solution. Additional doses may be given if Clinical Signs of Tetany develops.
v. Adequate urine output should be maintained using Diuretics if necessary.
vi. General supportive measures for Shock