The state medical examiner in Maryland ruled yesterday that an overdose of fluoride pumped into the Annapolis water supply more than two weeks ago contributed to the death of a 65-year-old man whose blood was being filtered through an artifical kidney machine.

State health officials said Dr. Homez Guard in the coroner's office found in an autopsy that "acute fluoride intoxication" was a factor in the death of Lawrence Blake, a kidney dialysis patient in Annapolis. Blake also suffered from high blood pressure, heart disease and hardening of the arteries, Guard said.

Public health officials said it also had been determined that the overdose was the result of an accident on the part of a waterworks employe.

The Annapolis Water Department said a manually operated valve was "inadvertently left open" overnight between Nov. 11 and 12. About 1,000 gallons of hyrdofluosilic acid were released into the public water supply and caused the fluoride content of the city's water to jump 15 times above its usual level.

Officials said the levels returned to normal by the end of last week and that the exposure to excess fluoride was not great enough to have caused illness in the general population.

Dr. David L. Sorley of the state health department said yesterday that city water officials failed to report the incident to federal authorities as required and suggested prompt reporting might have prevented Blake's death.

"I think there is a strong posibility if it had received widespread publicity when it had occurred, some of these side effects could have been prevented," Sorley told United Press International.

State health officials ordered the destruction of soft drink bottled in the city after the spill. But department spokesman Jon Crosby said the department had been unable to determine how many cases of Pepsi Cola and Coca-Cola already had been distributed by Annapolis' two bottling companies.

Dr. Gregory Mitchell, operator of a clinic that cleanses the blood of kidney patients by filtering it through dialysis machines, said eight of his patients became ill Nov. 13 while they were hooked up to the machines. One of the patients suffered a heart attack, Mitchell said, and he urged the others to enter Anne Arundel General Hospital for observation.

Mitchell said Blake refused and was found dead in his home a few hours later.

Sorley told reporters yesterday. "There is no indication the rest of the population was adversely affected" by the fluoride.

Dialysis patients would be particularly susceptible to an overdose because large amounts of fresh water are used in the blood-filtering process, officials said, and the fluoride went directly into their bloodstreams.