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Acute fluoride poisoning.

Fluoride poisoning is a potentially severe environmental hazard for children. A case of fluoride poisong is presented which was manifested by severe hypocalcemia, ventricular arrhythmias, and respiratory failure. Treatment of this poisoning, including peritoneal dialysis, is discussed. The kinetics of fluoride distribution as measured in this patient suggest a rapid binding of ingested fluoride to bone, followed by gradual release and excretion. Peritoneal dialysis resulted in no significant fluoride removal.

Calcium Hydroxide

[Effect of glutamine, thymidine and orotate on the nucleic acid content in the cell nuclei of the regenerating liver in sodium fluoride poisoning].

Sodium fluoride inhibits an increase of nucleic acids in the cells nuclei of the rat liver after a partial resection of this organ. Introduction of thymidine to the animals poisoned with sodium fluoride, contrary to glutamine and orotate, causes a sharp decrease in the amount of nuclei in 1 mg of tissue and normalization of the nucleic acid content in them. Changes in the mitotic activity may be connected with a disturbance in the normal ratio of the nucleic acids synthesis precursors.

Animals

Chronic fluoride poisoning in sheep.

Chronic fluoride poisoning in sheep and cattle was diagnosed on a farm in the Vredenburg district, Cape Province, and confirmed by laboratory analysis. The source of the poisoning was pastures contaminated with rock phosphate dust containing 2,1 to 3,3% of fluoride emitted from a fertilizer factory. Tabulated analyses of blood, liver, bone, pasture and water are given.

Animals

[Fluoride poisoning: mechanism, symptoms and treatment].

The use of fluorides in doses recommended by the International Dental Association is totally safe. Fluoride toxicity occurs only when these doses are exceeded. The human organism is capable of metabolizing fluoride when administered in low doses. Toxic doses though can cause signs and symptoms which vary from simple gastric disturbances to serious health problems or even death. The least fluoride dose which can cause signs and symptoms of fluoride poisoning is called possibly toxic dose. In the present paper the amount of 5 mgF-/kg is considered as the probably toxic dose of fluoride. In the case of accidental ingestion of a fluoride overdose the dentist should be also to calculate the amount of fluoride ingested. A simple method of calculating the amount of fluoride swallowed is presented in this paper. In addition the emergency treatment for fluoride overdoses is discussed. The danger of acute fluoride poisoning has increased lately, especially for children, due to the variety, pleasant taste smell and colour of fluoride products. Dentists should be able to estimate the toxic potential of fluoride in case of accidental poisoning and advise appropriate treatment.

Drug Overdose

[The clinical features of 160 cases of acute sodium silicon fluoride poisoning].

160 cases of acute sodium silicon fluoride poisoning due to accidental intake are reported in this paper. Owing to the great amount of the chemical taken, the onset was abrupt and the digestive symptoms were prominent and severe. Twelve cases had acute gastritis or acute ulceration as shown by gastroscopy. The cardiovascular findings were notable. Ninety-six cases had abnormal electro-cardiographic findings. Abnormal heart rhythm and S-T segment changes were the main findings. These changes were positively correlated with the toxin amount of fluoride. Two cases died from sudden arrest of heart beat. Lung, kidney, liver, and brain functions were also impaired. The authors suggested diagnostic criteria and control procedures.

Adolescent

Aortic calcification in chronic fluoride poisoning: biochemical and electronmicroscopic evidence.

Fluoride is known to cause ectopic calcification. The biochemical mechanism(s) involved in the initiation of calcification is not understood and the accompanying ultrastructural changes remain to be elucidated. Therefore, certain relevant parameters have been investigated in the aorta of rabbits administered fluoride, 10 mg NaF/kg body wt, every 24 hr for 17 and 24 months. The significant findings are: (i) degeneration of smooth muscle fibers in the tunica media of the aorta, (ii) presence of electron-dense granules in the mitochondria and on the inner surface of the plasma membrane of smooth muscle cells, (iii) presence of matrix vesicles with electron-dense deposits, (iv) enhanced calcium content and the Ca/P ratio, and (v) increased total glycosaminoglycan (GAG) content with reduced dermatan sulfate. The presence of electron-dense granules in the mitochondria, on the plasma membrane and matrix vesicles is suggestive of the process of calcification. The enhanced calcium content as well as the Ca/P ratio supports the view that the aorta is undergoing mineralization. The total GAG is enhanced, possibly due to an increase in the content of GAGs other than isomers of chondroitin. The observation that conveys an important message is that the dermatan sulfate normally known to exist in high concentrations in soft tissues begins to decrease as the process of calcification sets in. This perhaps would hold true and may serve as an index in the process of ectopic calcification.

Administration, Oral

Industrial fluoride pollution. Chronic fluoride poisoning in Cornwall Island cattle.

An aluminum plant on the south bank of the St. Lawrence river, southwest of Cornwall Island, Ontario, Canada, has emitted 0.816 metric tons of fluoride daily since 1973; considerably higher amounts were emitted from 1959 to 1973. The plant has been designated as the "major source of fluoride emissions impacting on Cornwall Island." Chronic fluoride poisoning in Cornwall island cattle was manifested clinically by stunted growth and dental fluorosis to a degree of severe interference with drinking and mastication. Cows died at or were slaughtered after the third pregnancy. The deterioration of cows did not allow further pregnancies. Fluoride concentrations in ash of biopsied coccygeal vertebrae increased significantly with age and were dependent on distance from and direction to the aluminum plant. Fluoride in bone ash of a 7-month old-fetus exceeded 500 ppm; fluoride thus was passed transplacentally. Analyses of fluoride in ash of bones obtained at necropsy of cattle from 4 months of age to 4 to 5 years of age showed increased amounts with age. Cancellous bone retained far higher amounts than cortical bone, a reflection of the normally higher metabolic rate of cancellous bone. Concentrations exceeding 10,000 ppm fluoride were recorded in cancellous bone of a 4-to 5-year-old cow. The target cells for fluoride in chronic fluorosis were shown to be the ameloblasts, the dental pulp cells and the odontoblasts and, in bone, primarily the resorbing osteocytes and also the osteoblasts. Atrophy and necrosis of the ameloblasts were responsible for enamel defects. The existing enamel showed brown discoloration from fluoride deposits. The pulp cells underwent fibrous and osseous metaplasia and necrosis of the ectopic bone occurred. The odontoblasts were atrophic and the dentin showed brown discoloration. The resorbing osteocytes were inactive and osteosclerosis resulted. This was especially pronounced in areas of normally great apposition, i.e. in the metaphyses. The epiphyseal plate became squeezed between petrotic bone and growth was stunted. Resorption of alveolar bone surrounding the deciduous teeth was severely retarded or arrested. A delay in eruption of permanent teeth occurred; it was up to 3.5 years in incisor teeth. Interference with the resorbing osteocytes in fluorotic bone was also demonstrated by loss of collagen birefringency in such bone. Failure of bone resorption also caused retention of trabecular bone in the cortices; this was observed even in a 4-t0-5-year-old cow. In areas where modeling into osteonic bone had begun, fluoride deposits were extremely heavy but this bone showed numerous soft osteons in microradiographs. The toxic effect of fluoride on osteocytes also resulted in the death of the cells. Such osteonecrosis occurred mainly in gnathic bone. There was atrophy of the osteoblasts. Osteopenia thus resulted from osteonecrosis and osteoporosis. Subperiosteal exostoses were not observed in long bones. The degree of fluorosis in Cornwall Island cattle was severe...

Air Pollutants

[Fluoride poisoning caused by rhubarb fruit juice--case report].

In the course of industrial-scale manufacture of unfermented rhubarb fruit juice, the deacidifying agent CaCl2 was confused with the disinfectant NH4HF2. Hence, fluoride in a quantity of up to 0.6 g/l was present in the unfermented fruit juice. Signs of acute fluoride poisoning were therefore seen after ingestion of the rhubarb juice. The incident as well as the steps taken by the relevant control authorities are described in detail.

Adult

[The mechanism of circulatory hypoxia in acute with sodium fluoride poisoning].

Intraperitoneal injection of a 1-sodium fluoride solution (35--40 mg/kg) to male rats was seen to cause a 8--9 fold rise of the blood histamine content and to significantly lower the oxygen tension in the musculus femorins. Preliminary administration of diprazine (5 mg/kg) prevented the death of the animals and lowered the degree of oxygen deficiency in the tissues. An interference is drawn on the important pathophysiological role played by an increase of the histamine content in the blood of the animals in the mechanism underlying the development of circulatory hypoxia in acute poisoning with sodium fluoride.

Animals