Acute skeletal fluorosis in the setting of 1,1-difluoroethane abuse

Ponce, Alex; Oakes, Jennifer A; Eggleston, William

doi:10.1080/15563650.2018.1527034

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Secondary hyperparathyroidism is also frequently noted [3,4]. While elevated serum, urine, and bone fluoride levels are usually seen, urinary fluoride levels can remain elevated despite normal serum levels following cessation of inhalant abuse, as occurred in our case (the patient had refrained for two months prior to presentation due to psychiatric hospitalization) [5][6][7].…”

Section: Discussionmentioning

confidence: 51%

Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse

Liane

Chow

Kline

2020

Cureus

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Skeletal fluorosis is a metabolic bone disease caused by accumulation of fluoride and is generally associated with chronic exposure to fluoride-contaminated groundwater, a phenomenon endemic to developing countries. Whereas elevated water fluoride concentrations do not constitute a public health issue in the United States, emergence of skeletal fluorosis as a sequela of chronic recreational exposures has been described. In this case report, our 33-yearold male patient with a history of major depressive disorder and substance abuse was hospitalized for hyperkalemia and acute kidney injury discovered on routine bloodwork due to concomitant nonsteroidal anti-inflammatory drugs (NSAID) and antihypertensive use. Upon hospital admission, he was found to be anemic with a significantly elevated alkaline phosphatase. Given a history of low back pain in the setting of these laboratory abnormalities, lower spine and pelvic imaging revealed diffusely increased bone density and sclerosis. Hematologic evaluation ensued to include a peripheral smear and bone marrow biopsy. Given the patient's history of computer cleaner inhalant abuse, serum and urinary fluoride levels were obtained. Serum fluoride returned within normal limits though urinary fluoride was increased. Bone marrow histopathology revealed prominent diffuse sclerosis which in conjunction with urinary fluoride levels and computer cleaner inhalant abuse history supported the diagnosis of skeletal fluorosis. Skeletal fluorosis in the United States is rare and presents with non-specific findings requiring a high index of suspicion based on a detailed patient history for expedient diagnosis.

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Section: Discussionmentioning

confidence: 51%

Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse

Liane

Chow

Kline

2020

Cureus

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“…However, he denied high F exposure including from excess black tea, (6)(7)(8)(19)(20)(21)(22) ingestion of toothpaste, (16,21,23) or inhalation of a fluorocarbon. (17,(24)(25)(26)(27)(28) Then, his mother revealed that he had inhaled several times daily for 2-3 years, reportedly for pain control, computer 'duster' that we found contains difluoroethane (DFE). Subsequently, the patient confirmed this practice, using Dust-Off (Falcon Safety Products, Branchburg, JN, USA), but despite his skeletal disease indicating more prolonged exposure was adamant the duration was not longer.…”

Section: C) Sf Diagnosis and Treatmentmentioning

confidence: 99%

Non-endemic skeletal fluorosis: Causes and associated secondary hyperparathyroidism (case report and literature review)

Cook

Seagrove-Guffey

Mumm

et al. 2021

Bone

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“…Although low doses of fluoride are used to prevent dental carries and treat osteoporosis by replenishing cortical and trabecular bone, excessive doses overstimulate osteoblasts, causing elevated levels of their byproduct alkaline phosphatase, leading to abnormal osteosclerosis and periosteal bone formation as seen in this case. Fluoride incorporates into hydroxyapatite crystals, increasing their size and reducing their solubility as new fluorapatite crystals, making the bone more resistant to breakdown by parathyroid hormone 2,5–8 . This patient lives at a campsite, where fluoride-treated water possibly potentiated the effects of her inhalant abuse.…”

mentioning

confidence: 99%

“…Fluoride incorporates into hydroxyapatite crystals, increasing their size and reducing their solubility as new fluorapatite crystals, making the bone more resistant to breakdown by parathyroid hormone. 2,[5][6][7][8] This patient lives at a campsite, where fluoride-treated water possibly potentiated the effects of her inhalant abuse. Reports indicate that with cessation and sobriety from excessive exposure, recovery is possible, with rapid abatement of pain, but prolonged skeletal changes owing to the 7-year half-life of fluoride in the bone.…”

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confidence: 99%

An Enigmatic Case of Skeletal Fluorosis

DeMarco,

Major,

Young

et al. 2023

Clin Nucl Med

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Skeletal fluorosis is more common in the developing world, but is occasionally seen in the United States. We present radiographic, scintigraphic, CT, and clinical images of a 26-year-old woman with rapidly progressive, debilitating, polyostotic periostitis, and diffuse osteosclerosis typical of skeletal fluorosis. Laboratory analyses supported this diagnosis. The source of excess fluoride intake was elusive until a concurrent mental health workup revealed the patient’s proclivity for inhaling air-duster cans containing difluoroethane. Difluoroethane inhalant abuse is an increasingly reported cause of skeletal fluorosis that astute clinicians should recognize. Discontinuation and sobriety from this toxic agent are essential for recovery.

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Acute skeletal fluorosis in the setting of 1,1-difluoroethane abuse

Cited by 6 publications

References 6 publications

Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse

Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse

Non-endemic skeletal fluorosis: Causes and associated secondary hyperparathyroidism (case report and literature review)

An Enigmatic Case of Skeletal Fluorosis

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