Potassium Fluoride

CAS RN:7789-23-3

Health Effects

0.2.1 SUMMARY OF EXPOSURE
  • 0.2.1.1 ACUTE EXPOSURE
    • A) USES: Several fluoride salts are used in dental products. Chronic fluoride poisoning (fluorosis) may occur in areas where the water has very high fluoride concentrations. Fluoride-liberating chemicals (such as ammonium fluoride, ammonium bifluoride, and sodium fluorosilicate) are used in some automobile wheel cleaners and rust removers. Sodium fluoride was used as a rodenticide. Hydrofluoric acid (HF) is used in etching glass and cleaning silicon chip products. Ammonium bifluoride and hydrofluoric acid are covered in separate managements.
    • B) PHARMACOLOGY: Fluoride promotes remineralization of decalcified dental enamel and may interfere with the growth of bacteria in dental plaque.
    • C) TOXICOLOGY: Sodium fluoride reacts with the gastric acid to form hydrofluoric acid. The major toxic effects of fluoride are due to the chelation of calcium and magnesium. In tissue, the local hypocalcemia causes pain and cellular death. Systemic hypocalcemia and hypomagnesemia may cause cardiac dysrhythmias and cardiovascular collapse. Fluoride opens the calcium-dependent potassium channels on erythrocytes resulting in hyperkalemia. Fluoride also impairs oxidative phosphorylation. Long-term ingestion of water with high fluoride concentrations results in weak and brittle bones (fluorosis).
    • D) EPIDEMIOLOGY: Dermal exposures are common. Systemic fluoride poisoning is uncommon, but deaths are reported to poison centers each year, primarily from exposure to hydrofluoric acid. Toxicity is very rare following exposure to household dental products (toothpaste and dental rinses), but is theoretically possible following ingestion of fluoride supplements. Fluorosis is common in some areas of Asia due to high fluoride content of water.
    • E) WITH POISONING/EXPOSURE
      • 1) MILD TO MODERATE TOXICITY: Acute ingestion of dental products containing sodium fluoride generally causes minor gastrointestinal upset. Skin exposure to household products with higher concentrations of fluoride ion results in pain that develops slowly. The tissue may appear normal but the patient can have severe pain. Over time the skin may become hyperemic with subsequent blanching and cogitative necrosis. Eye exposure can cause irritation and corneal edema; if fluoride concentration is higher, conjunctival ischemia and chemosis may develop. Inhalation causes minor upper respiratory tract irritation. Nausea and vomiting frequently occurs within 30 to 60 minutes of ingestion.
      • 2) SEVERE TOXICITY: Severe toxicity generally only develops after exposure to industrial products containing fairly high concentrations of sodium fluoride or sodium bifluoride. Severe burns (ocular and dermal) may occur following exposure to higher concentration products. Burns involving more than 5% body surface area (BSA) from low concentration products or more than 1% BSA from high concentration products may produce systemic fluoride poisoning. Systemic toxicity most commonly occurs following ingestion, but may occur following dermal or inhalational exposure. Inhalation may cause acute lung injury from direct tissue injury. Symptoms of serious toxicity include skeletal muscle weakness and spasm, respiratory muscle weakness, and respiratory arrest. Ventricular dysrhythmias and fibrillation are thought to be the main cause of death. Patients may have severe toxicity without significant oral or gastrointestinal symptoms.
0.2.3 VITAL SIGNS0.2.5 CARDIOVASCULAR
  • 0.2.5.1 ACUTE EXPOSURE
    • A) Cardiac dysrhythmias consistent with hyperkalemia may be noted. Fatal cardiac arrest occurred in several patients with renal failure exposed to fluoride during hemodialysis. QT prolongation secondary to hypocalcemia can occur following fluoride toxicity.
0.2.6 RESPIRATORY
  • 0.2.6.1 ACUTE EXPOSURE
    • A) Respirations are first stimulated then depressed. Death is usually from respiratory muscle paralysis. Following inhalation, coughing and choking may be noted.
0.2.7 NEUROLOGIC
  • 0.2.7.1 ACUTE EXPOSURE
    • A) Hyperactive reflexes, painful muscle spasms, weakness and tetanic contractures may be noted due to fluoride induced hypocalcemia.
0.2.8 GASTROINTESTINAL
  • 0.2.8.1 ACUTE EXPOSURE
    • A) Epigastric pain, nausea, dysphagia, salivation, hematemesis, and diarrhea can occur. These effects may be delayed for several hours following oral exposure. GI symptoms can develop following fluoride ingestions of 3 mg/kg or more.
0.2.9 HEPATIC
  • 0.2.9.1 ACUTE EXPOSURE
    • A) An increase of hepatic enzymes have been reported following sodium fluoride toxicity.
0.2.12 FLUID-ELECTROLYTE
  • 0.2.12.1 ACUTE EXPOSURE
    • A) Hyperkalemia and hypomagnesemia may occur following fluoride toxicity. Hypocalcemia is likely to develop with acute exposure.
0.2.14 DERMATOLOGIC
  • 0.2.14.1 ACUTE EXPOSURE
    • A) Urticaria and pruritus have been reported following dermal exposure to fluoride.
0.2.20 REPRODUCTIVE HAZARDS
  • A) Prenatal fluoride supplementation (2.2 mg NaF or 1 mg fluoride daily) during the last two trimesters of pregnancy has been reported to be safe.
0.2.21 CARCINOGENICITY
  • 0.2.21.1 IARC CATEGORY
    • A) IARC Carcinogenicity Ratings for CAS16984-48-8 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
      • 1) IARC Classification
        • a) Listed as: Fluorides (inorganic, used in drinking-water)
        • b) Carcinogen Rating: 3
      • 1) The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.
0.2.23 OTHER
  • 0.2.23.1 ACUTE EXPOSURE
    • A) CHRONIC EXPOSURE: Prolonged exposure to fluorinated water may cause fluorosis. Signs and symptoms of fluorosis include brittle bones, calcified ligaments, and other crippling changes.

0.2.1 SUMMARY OF EXPOSURE

  • 0.2.1.1 ACUTE EXPOSURE
    • A) USES: Hydrogen fluoride (HF) is an irritant gas used in chemical manufacturing or a solution used for rust removal, glass etching, and silicon semiconductor chip manufacturing.
    • B) TOXICOLOGY: Highly electronegative fluoride ion penetrates tissues deeply and binds calcium leading to hypocalcemia (and hypomagnesemia), tissue burns (rare) and cell death.
    • C) EPIDEMIOLOGY: Poisoning is uncommon with mostly minor and moderate outcomes, but may be life-threatening. Usually occurs via dermal route but occasionally ocular, ingestion or inhalation. Severe poisoning most often occurs after ingestion, but may develop from a dermal exposure of a large surface area and/or to a high concentration product.
    • D) WITH POISONING/EXPOSURE
      • 1) MILD TO MODERATE TOXICITY: DERMAL: Exposure can result in delayed, unrelenting, severe pain without visible signs of injury. OCULAR: Exposure can cause mucosal irritation. INHALATION: Inhalation of low concentrations may cause prompt mucosal irritation, dyspnea, cough and wheezing. INGESTION: GI irritation (ie, nausea, vomiting, diarrhea, dysphagia, abdominal pain) may be expected following ingestion.
      • 2) SEVERE TOXICITY: DERMAL: Tissue destruction or necrosis may be caused by dermal exposures to large amounts of or highly concentrated solutions of HF, and may result in systemic poisoning. OCULAR: Ocular exposure to liquid HF produces rapid pain, conjunctival injection, corneal abrasion or ulceration, progressive corneal vascularization and stroma scarring, and corneal opacification. Permanent visual deficits may occur in severe cases. INGESTION: Significant gastrointestinal burns may be expected after significant exposure. Painful necrotic lesions, hemorrhagic gastritis, and pancreatitis have been reported after significant exposure. Ingestion or inhalation may cause systemic poisoning with hypocalcemia, ventricular dysrhythmias (prolonged QTc, torsades de pointes), hyperkalemia, hypomagnesemia, acidosis and cardiac arrest. Cardiac toxicity generally manifests within 6 hours of an exposure. INHALATION: Dyspnea, bronchospasm (with abnormal PFTs and hypoxia), chemical pneumonitis, pulmonary edema (can be hemorrhagic), tracheobronchitis, upper airway obstruction, chemical burns (larynx, trachea, bronchi) , ARDS, and respiratory failure may occur following inhalation. Ingestion of more than 30 mL of a 5% solution can be fatal.
  • 0.2.1.2 CHRONIC EXPOSURE
    • A) Hydrogen fluoride and hydrofluoric acid are extreme irritants to any part of the body that they contact. The main route of exposure to hydrogen fluoride is inhalation, followed by dermal contact for acute exposure and ingestion for chronic exposure. Symptoms of the chronic effects of hydrofluoric acid include weight loss, malaise, anemia, leukopenia, discoloration of teeth, and osteosclerosis.
0.2.21 CARCINOGENICITY
  • 0.2.21.1 IARC CATEGORY
    • A) IARC Carcinogenicity Ratings for CAS7664-39-3 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
      • 1) Not Listed
  • 0.2.21.2 HUMAN OVERVIEW
    • A) At the time of this review, no studies were found on the possible carcinogenic activity of fluoride in humans.
0.2.22 GENOTOXICITY
  • A) DNA damage and chromosome aberrations have been reported in insect studies.
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