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"Fluoride has several mechanisms of
toxicity. Ingested fluoride initially acts locally on the intestinal
mucosa. It can form hydrofluoric acid in the stomach, which leads to GI
irritation or corrosive effects. Following ingestion, the GI tract is
the earliest and most commonly affected organ system.
Once absorbed, fluoride binds calcium ions
and may lead to hypocalcemia.
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Fluoride has direct cytotoxic effects and interferes with a number of
enzyme systems; it disrupts oxidative phosphorylation, glycolysis,
coagulation, and neurotransmission (by binding calcium).
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Fluoride inhibits Na+/K+ -ATPase, which may lead to hyperkalemia by
extracellular release of potassium.
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Fluoride inhibits acetylcholinesterase, which may be partly responsible
for hypersalivation, vomiting, and diarrhea (cholinergic signs).
Seizures may result from both hypomagnesemia and hypocalcemia.
Severe fluoride toxicity will result in
multiorgan failure. Central vasomotor depression as well as direct
cardiotoxicity also may occur. Death usually results from respiratory
paralysis, dysrhythmia, or cardiac failure."
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