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Use of Fluoridated Water in Long-Term Hemodialysis

Use of Fluoridated Water in Long-Term Hemodialysis Abstract THE FLUORIDE concentration in fluoridated water (1 ppm) is normally about six times that in serum. Therefore, when such water is used in the dialysate bath of an artificial kidney, fluoride ions would be expected to move into the patient's blood. How much of the fluoride is absorbed from the dialysate has not been reported, but the volume of the dialysate would generally be at least 200 liters, representing 200 mg of fluoride. The amount absorbed would depend at least in part on the average concentrations of fluoride in the serum during dialysis. This is a report of the absorption of fluoride by a patient with chronic renal insufficiency who underwent dialysis repeatedly with fluoridated water in the dialysate bath. Report of Case The patient was a 41-year-old nurse who had had proteinuria for over 20 years, hypertension for 11 years subsequent to a pregnancy, and periodic urinary tract References 1. This figure assumes 1 kg of ash with an average concentration of 4,000 ppm of fluoride, estimates based on a 40% reduction in bone mass due to osteoporosis and a fluoride concentration in the long bones half that in the vertebrae.13 For detailed estimates of bone mass see ref 14. 2. Smith, F. A., and Gardner, D. E.: Investigations on Metabolism of Fluoride in Blood , J Dent Res 30:182, 1951.Crossref 3. Gardner, D. E., and Smith, F. A.: Determination of Fluoride in Urine , Amer Industr Hyg Assoc Quart 16:215, 1955. 4. Singer, L., and Armstrong, W. D.: Determination of Fluoride in Blood Serum , Analyt Chem 31:105, 1959.Crossref 5. Hodge, H. C.: " Fluoride ," in Mineral Metabolism , vol 2, pt A, The Elements, edited by Comar, C. L. and Bronner, F., New York: Academic Press, Inc., 1964. 6. Rich, E.; Ensinck, J.; and Ivanovich, P.: Effects of Sodium Fluoride on Calcium Metabolism of Subjects With Metabolic Bone Disease , J Clin Invest 43:545, 1964.Crossref 7. Armstrong, W. D., et al: Plasma Fluoride Concentrations of Patients Treated With Sodium Fluoride , J Clin Invest 43:555, 1964. 8. Wallace-Durbin, P.: Metabolism of Fluorine in Rat Using F18 as Tracer , J Dent Res 33:789, 1954.Crossref 9. Johnson, L. C.: " Histogenesis and Mechanisms in Development of Osteofluorosis ," in Fluorine Chemistry , J. H. Simons, ed., vol 4, H. C. Hodge, and F. A. Smith, eds., New York: Academic Press, Inc., to be published. 10. Johnson, L. C.: "Morphological Analysis in Pathology," in Frost, H. M., ed.: Bone Biodynamics, in International Symposium on Bone Biodynamics, held at Henry Ford Hospital, March, 1963, Boston: Little Brown & Co., 1964, chap 29, pp 556-558. 11. Johnson, L. C.: Personal communication to the authors. 12. Zipkin, I., et al: Fluoride Deposition in Human Bones After Prolonged Ingestion of Fluoride in Drinking Water , Public Health Rep 73:732, 1958.Crossref 13. Hodge, H. A.: Metabolism of Fluorides , JAMA 177:313, 1961.Crossref 14. Wolff, W. A., and Kerr, E. G.: Composition of Human Bone in Chronic Fluoride Poisoning , Amer J Med Sci 195:493, 1938.Crossref 15. Krogman, W. M. (ed.): The Human Skeleton in Forensic Medicine , Springfield, Ill: Charles C Thomas, 1962. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Use of Fluoridated Water in Long-Term Hemodialysis

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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1965 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1965.03860140047010
Publisher site
See Article on Publisher Site

Abstract

Abstract THE FLUORIDE concentration in fluoridated water (1 ppm) is normally about six times that in serum. Therefore, when such water is used in the dialysate bath of an artificial kidney, fluoride ions would be expected to move into the patient's blood. How much of the fluoride is absorbed from the dialysate has not been reported, but the volume of the dialysate would generally be at least 200 liters, representing 200 mg of fluoride. The amount absorbed would depend at least in part on the average concentrations of fluoride in the serum during dialysis. This is a report of the absorption of fluoride by a patient with chronic renal insufficiency who underwent dialysis repeatedly with fluoridated water in the dialysate bath. Report of Case The patient was a 41-year-old nurse who had had proteinuria for over 20 years, hypertension for 11 years subsequent to a pregnancy, and periodic urinary tract References 1. This figure assumes 1 kg of ash with an average concentration of 4,000 ppm of fluoride, estimates based on a 40% reduction in bone mass due to osteoporosis and a fluoride concentration in the long bones half that in the vertebrae.13 For detailed estimates of bone mass see ref 14. 2. Smith, F. A., and Gardner, D. E.: Investigations on Metabolism of Fluoride in Blood , J Dent Res 30:182, 1951.Crossref 3. Gardner, D. E., and Smith, F. A.: Determination of Fluoride in Urine , Amer Industr Hyg Assoc Quart 16:215, 1955. 4. Singer, L., and Armstrong, W. D.: Determination of Fluoride in Blood Serum , Analyt Chem 31:105, 1959.Crossref 5. Hodge, H. C.: " Fluoride ," in Mineral Metabolism , vol 2, pt A, The Elements, edited by Comar, C. L. and Bronner, F., New York: Academic Press, Inc., 1964. 6. Rich, E.; Ensinck, J.; and Ivanovich, P.: Effects of Sodium Fluoride on Calcium Metabolism of Subjects With Metabolic Bone Disease , J Clin Invest 43:545, 1964.Crossref 7. Armstrong, W. D., et al: Plasma Fluoride Concentrations of Patients Treated With Sodium Fluoride , J Clin Invest 43:555, 1964. 8. Wallace-Durbin, P.: Metabolism of Fluorine in Rat Using F18 as Tracer , J Dent Res 33:789, 1954.Crossref 9. Johnson, L. C.: " Histogenesis and Mechanisms in Development of Osteofluorosis ," in Fluorine Chemistry , J. H. Simons, ed., vol 4, H. C. Hodge, and F. A. Smith, eds., New York: Academic Press, Inc., to be published. 10. Johnson, L. C.: "Morphological Analysis in Pathology," in Frost, H. M., ed.: Bone Biodynamics, in International Symposium on Bone Biodynamics, held at Henry Ford Hospital, March, 1963, Boston: Little Brown & Co., 1964, chap 29, pp 556-558. 11. Johnson, L. C.: Personal communication to the authors. 12. Zipkin, I., et al: Fluoride Deposition in Human Bones After Prolonged Ingestion of Fluoride in Drinking Water , Public Health Rep 73:732, 1958.Crossref 13. Hodge, H. A.: Metabolism of Fluorides , JAMA 177:313, 1961.Crossref 14. Wolff, W. A., and Kerr, E. G.: Composition of Human Bone in Chronic Fluoride Poisoning , Amer J Med Sci 195:493, 1938.Crossref 15. Krogman, W. M. (ed.): The Human Skeleton in Forensic Medicine , Springfield, Ill: Charles C Thomas, 1962.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1965

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