Fluoride toxicity is characterized by a variety of signs and symptoms. In the United States, poisoning most commonly follows ingestion (accidental or intentional) of fluoride-containing products. However, in many parts of the world (eg, regions of India and China), elevated levels of fluoride in groundwater result in chronic fluoride toxicity (fluorosis).[1] Potentially toxic levels of fluoride have also been found in well water in the US.[2]
Fluoride is found in many common household products, including the following:
Toothpaste (eg, sodium monofluorophosphate)
Vitamins
Dietary supplements (eg, sodium fluoride)
Glass-etching or chrome-cleaning agents (eg, ammonium bifluoride)
Insecticides and rodenticides (eg, sodium fluoride)
Historically, most cases of serious acute fluoride toxicity have followed accidental ingestion of insecticides or rodenticides.
Symptom onset usually occurs within minutes of exposure, but may be delayed. Manifestations of fluoride toxicity are predominantly gastrointestinal (GI), but neurologic and cardiovascular effects also occur (see Presentation).
Tests for measuring fluoride levels are not available in the emergency department. Assessment of patients with suspected fluoride toxicity is directed toward the consequences of the toxicity, and may include the following:
Electrocardiogram
Electrolyte levels
Fingerstick glucose assay
No antidote for fluoride toxicity exists, and fluoride does not adsorb to activated charcoal. Treatment includes gastric aspiration and lavage, and correction of electrolyte abnormalities. (See Treatment and Medication.)
For patient education information, see the First Aid and Injuries Center, as well as Poisoning and Poison Proofing Your Home.