Fluoride poisoning 1027729 222689161 2008-06-30T17:05:11Z ClueBot 4928500 Reverting possible vandalism by [[Special:Contributions/92.8.195.191|92.8.195.191]] to version by Anthony Appleyard. False positive? [[User:ClueBot/FalsePositives|Report it]]. Thanks, [[User:ClueBot]]. (429023) (Bot) {{Refimprove|date=August 2007}} {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 29228 | ICD10 = | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = emerg | eMedicineTopic = 181 | MeshID = D005458 | }} {{toxicology}} In high concentrations, soluble [[fluoride]] [[salts]] are mildly [[toxic]]: 5-10 grams of [[sodium fluoride]] are required to kill most adult humans; a lethal dose is approximately 70 mg per kilogram of body mass.<ref name=Aigueperse>Jean Aigueperse, Paul Mollard, Didier Devilliers, Marius Chemla, Robert Faron, Renée Romano, Jean Pierre Cuer, “Fluorine Compounds, Inorganic” in Ullmann’s Encyclopedia of Industrial Chemistry 2005 Wiley-VCH, Weinheim. DOI 10.1002/14356007.a11 307</ref> [[Organofluorine]] compounds do not contain soluble fluoride and thus are not toxic because of fluorine. Organofluorines include many kinds of compounds such as [[Teflon]] and [[fluoxetine]]. Like most soluble materials, fluoride compounds are readily absorbed by the intestines and [[excretion|excreted]] through the urine over the course of hours. Trace amounts are incorporated in bone. [[Urinalysis|Urine tests]] are a good indication of high exposure to fluoride compounds in the recent past. Skin or eye contact with many fluoride salts (in high concentrations) is dangerous. ==Fluorosis== Although there is some contradictory evidence on the issue,[http://www.fluoridealert.org] the only generally accepted adverse effect of high concentration [[water fluoridation]] at this time is [[dental fluorosis]]. It is a condition caused by 'excessive' intake of fluoride ions over an extended period of time during [[tooth development]] (before teeth erupt into the mouth), and can cause yellowing of teeth, [[hypothyroidism]], or [[brittle|brittling]] of [[bone]]s and [[teeth]]. The definition of 'excessive' in the context of fluorosis falls on the order of parts per million (ppm) and is generally accepted to mean significantly higher than the 0.7 to 1.2 ppm amounts recommended for fluoridated water. Fluoride in small amount is considered by most dentists to be beneficial to teeth (see [[Fluoride therapy]]). One of the side effects of fluoride poisoning is gastro-intestinal inflammation as fluoride toxicity has a corrosive effect on the mucous membrane which line the gut.<ref name="emerg181">[http://www.emedicine.com/EMERG/topic181.htm eMedicine - Toxicity, Fluoride : Article by Geofrey Nochimson<!-- Bot generated title -->]</ref> Among the potential metabolic disturbances reported caused by fluoride toxicity is the increased impact of the natural plant toxin, salicylate,<ref name="emerg181"/>, which may have particular significance in subgroups who already have high incidence of [[salicylate]] intolerance such as the [[ADHD]] and [[autism]] populations (see [[Autism therapies]]). == Possible sources == Historically, most cases of fluoride poisoning have been caused by accidental ingestion of [[insecticide]]s or [[rodenticide]]s. * [[Glass-etching]] or [[Chrome-cleaning]] agents like [[ammonium bifluoride]] * Industrial exposure to [[flux]]es used to lower melting points of metals. * [[Insecticides]] containing [[sodium fluoride]] * [[Rodenticides]] containing [[sodium fluoride]] * Fluoride in [[volcanic]] [[ejecta]], for example in cattle grazing after a 1845 - 1846 eruption of [[Hekla]], and the 1783-1784 flood basalt eruption of [[Laki]] ==Chronic toxicity== This article is focused on acute toxicity: the results of ingesting a large amount of fluoride in a short period of time. Chronic toxicity, the result of ingesting small amounts of fluoride over a long period of time, results in [[dental fluorosis]] and [[skeletal fluorosis]]. These conditions are seen in areas where there is natural fluoride in the drinking water at levels above that added in public water supplies in the United States. {{Fact|date=March 2008}} ==Symptoms of acute toxicity== Fluoride toxicity is characterized by a variety of signs and symptoms. Symptom onset usually occurs within minutes of exposure. Severity of symptoms can depend on the amount of fluoride compounds ingested. Symptoms of fluoride poisoning point towards some kind of profound metabolic dysfunction, very similar to the symptoms of [[hypothyroidism]]. === [[Gastrointestinal]] === When poisoned by fluoride, gastrointestinal signs predominate. * [[Abdominal pain]] * [[Diarrhea]] * [[Dysphagia]] * [[Hypersalivation]] * [[Mucosal injury]] * [[Nausea]] * [[Vomiting]] === [[Electrolyte]] abnormalities === * [[Hyperkalemia]] * [[Hypocalcemia]] * [[Hypoglycemia]] * [[Hypomagnesemia]] === [[Neurology|Neurologic]] effects === * [[Headache]] * [[Hyperactive]] [[reflexes]] * [[Muscle weakness]] * Muscular [[spasm]] * [[Paresthesia]] * [[Seizures]] * [[Tetanic contraction]]s * [[Tremor]] === [[Cardiovascular]] === * [[Cardiac arrest]] * [[Shock (medical)|Shock]] * [[Electrical conduction system of the heart|Widening of QRS]] * Various [[arrhythmia]]s == Method of action == Ingested fluoride initially acts locally on the intestinal mucosa. It can form hydrofluoric acid in the stomach, which leads to [[gastrointestinal]] irritation or corrosion. After ingestion, the gastrointestinal tract is the earliest and most commonly affected organ system. == Treatment == In case of accidental swallowing, give milk, [[calcium carbonate]] or [[milk of magnesia]] to slow absorption. Eye or skin contact should be treated by removing any contaminated clothing and flushing with water. == References == {{reflist}} == External links == *[http://www.287reasons.com "287" The Body Burden Movie for Theatrical Release 2008 will cover fluoride poisoning] *[http://287themovie.wordpress.com The "287" Body Burden blog] *[http://www.fluoridealert.org Fluoride Action Network] An international coalition seeking to broaden public awareness about the toxicity of fluoride compounds and the health impacts of current fluoride exposures. *[http://www.emedicine.com/emerg/topic181.htm eMedicine article about Fluoride Toxicity by Geoffrey Nochimson, MD] *[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8259189&dopt=Abstract Acute fluoride poisoning from a public water system. Gessner BD, Beller M, Middaugh JP, Whitford GM.] *[http://www.fluoride-journal.com/97-30-2/302-89.htm Re-Examination of Acute Toxicity of Fluoride, by Kenji Akiniwa, Tokyo, Japan] *[http://bruha.com/pfpc/ Website of the "Parents of Fluoride poisoned children" foundation] *[http://www.slweb.org/galletti.html] fluoride may be used reliably to reduce thyroid function. This is therapeutic with hyperthyroidism. *[http://www.bruha.com/pfpc/html/symptoms.html] Since fluorides reduce thyroid function, the full list of conditions associated with hypothyroidism(177 conditions) is also present in fluoride poisoning. * [http://www.emedicine.com/EMERG/topic181.htm impact of fluoride toxicity on salicylate levels and gut inflamation] {{Poisoning and toxicity}} [[Category:Toxicology]] [[Category:Element toxicology]]