Acute toxicity of ingested fluoride

Q: All of the following can happen in Flouride toxicity EXCEPT? - select one

A) Hypokalemia

B) Hypocalcemia

C) Hypoglycemia

D) Hypomagnesemia

Answer: A

Electrolyte imbalance is a major concern in fluoride toxicity. It results in hyperkalemia, hypocalcemia, hypoglycemia, and hypomagnesemia.

Fluoride overdose occurs due to over-ingestion of toothpaste, vitamins, and dietary supplements. The ingestion of insecticides and rodenticides (e.g., sodium fluoride) is the main concern. Ingested fluoride can form hydrofluoric acid in the stomach and lead to corrosive effects. Once absorbed, fluoride binds calcium and leads to hypocalcemia. Fluoride has direct cytotoxic effects and interferes with several enzyme systems. Fluoride inhibits Na /K ATPase, which may lead to hyperkalemia by extracellular release of potassium. Seizures may result from severe hypomagnesemia.

There is no antidote and the treatment is electrolyte correction.

#toxicity

#electrolytes

References:

1. Vieira AR. Fluoride Toxicity. Monogr Oral Sci. 2021;30:140-148. doi: 10.1159/000520789. Epub 2022 Jan 25. PMID: 35078188.

2. Johnston NR, Strobel SA. Principles of fluoride toxicity and the cellular response: a review. Arch Toxicol. 2020 Apr;94(4):1051-1069. doi: 10.1007/s00204-020-02687-5. Epub 2020 Mar 9. PMID: 32152649; PMCID: PMC7230026.

3. Whitford GM. Acute toxicity of ingested fluoride. Monogr Oral Sci. 2011;22:66-80. doi: 10.1159/000325146. Epub 2011 Jun 23. PMID: 21701192.