2011/10/05 Council Agenda Packet

Nine accidents involving the introduction of excess fluoride into community water supplies in the United States have been reported during the 'last decade. In all but one of these accidents, .only a small proportion of the population became 11l with mild transient gastrointestinal symptoms. After a spillage accident in Annapolis, Maryland in 1979, in which the fluoride concentration of tap water reached 50 times the recommended level, only a small percentage of the total population exposed became ill with gastrointestinal symptoms. However, for eight persons who were undergoing artificial kidney treatments at the time, the use of the high-fluoride water in preparation of the dialysate resulted in a marked elevation of serum concentrations of fluoride and symptoms of fluoride intoxication. In addition, one patient suffered a cardiorespiratory arrest which was reversible and another patient, died within 24 hours of exposure, which presumably also was related to acute fluoride intoxication.5 _ It is recommended that (1) for patients undergoing long term dialysis; water used- for preparation of dialysate be treated and appropriately monitored according to the AAMI proposed standards for hemodialysis systems.6 In addition, (2) water treatment officials should develop and maintain emergency plans so that susceptible individuals and health officials are promptly notified of the occurrence of any situations involving water used for dialysis which may pose a major health risk. (3) Fluoride concentration monitoring at water treatment plants should be capable of detecting the actual fluoride levels directly. (4) It would also seem prudent to monitor the fluoride intake of patients with chronic renal impairment, particularly those living in areas of high naturally occurring fluoride, children, those with excessive fluoride intake, and those with prolonged disease. There is insufficient evidence at this time to recommend the use of fluoride-free drinking water for all patients with renal disease.