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Toothpaste Ingestion

A Toothpaste Ingestion that Resulted in Poisoning: A Real Case and Discussion

A Case Report presented at the 2007 North American Congress of Clinical Toxicology Annual Meeting, New Orleans

Schaeffer SE: Hypocalcemia and Dysrhythmia in a Pediatric Patient Following Toothpaste Ingestion.

The Oklahoma Poison Control Center was contacted by the mother of a 2 yo male to report her son had ingested up to five ounces of toothpaste, active ingredient 0.15% fluoride, and had already vomited twice.

The child was referred to the emergency department (ED). Initial examination, performed 2 to 3 hours post-exposure, revealed a healthy-appearing child whose only complaint was abdominal pain.

Pertinent initial labs included a normal calcium and magnesium blood level.  An electrocardiogram in the ED revealed some rhythm abnormalities.

Milk was given to drink, the child was started on an oral magnesium-containing antacid every six hours, and he was admitted for monitoring of cardiac rhythm and electrolytes.

Ten hours post-ingestion, laboratory levels included a calcium level of 0.95 mmol/L (normal 1.12 – 1.32) and magnesium 1.7 mg/dL (normal 1.6 – 2.6).  One dose of calcium was administered intravenously.

Fourteen hours post-ingestion the child’s calcium and magnesium levels were normal and his cardiac rhythm was normal. He was discharged after two days of observation.

Discussion: Toothpaste Ingestions in Children

This child’s decreased calcium and borderline magnesium levels were temporally related to the fluoride exposure from ingesting a large amount of toothpaste.

Both the electrolyte disturbances and cardiac rhythm disturbance were resolved after administration of oral and IV calcium.

  • In 2006, the American Association of Poison Control Centers reported that children younger than 6 years had a total of 19,522 exposures to toothpaste with flouride. The overwhelming majority of these kids did not require referral to an ER and no cases resulted in major health effects or death.

  • Ingestion of fluoride-containing toothpaste in a child typically results in a benign course, with the most frequently observed toxic effects being nausea and vomiting from gastric irritation.

  • Large exposures, which are unusual, may result in significant toxicity, including low calcium and magnesium blood levels, heart rhythm disturbances and neurological problems such as tremors or seizures.

How much toothpaste does my child have to swallow to become a concern?

The following table shows how much toothpaste with fluoride would have to be ingested for the Georgia Poison Center to recommend an ER evaluation for your child:

TABLE:
How much ingested toothpaste requires ER evaluation? 
Age of Child
Average Weight*
Dose of Fluoride

Percent of
“Colgate for Kids”
toothpaste which,
if swallowed, requires ER evaluation
**

1 years
~10 kg
60 mg

~42% of tube

2 years
~12 kg 72 mg
~52% of tube
3 years
~15 kg
90 mg
~63% of tube
4 yrs ~16 kg  96 mg ~67% of tube
* Potentially toxic dose = 6 mg of fluoride per kg of body weight.
This is “the minimum dose that could cause toxic signs and symptoms (SOURCE: Georgia Poison Control Center)

What should I do if my child eats toothpaste with fluoride from the toothpaste tube?

  • Give your local poison center a call at 1-800-222-1222.
  • Based on the amount possibly ingested and the development of any symptoms, the center will give you advice on whether you can safely stay home or go to the ER with your child.
  • If you can be watched at home, they will most likely recommend that you give your child some milk.