A case of cardiac arrest after dermal exposure to 2.38% tetramethylammonium hydroxide

ABSTRACT

A 34-year-old man presented with an out-of-hospital cardiac arrest shortly after dermal exposure to tetramethylammonium hydroxide (TMAH). The patient was accidentally exposed to 2.38% TMAH despite the use of personal protective equipment and was referred to our emergency department one hour after the exposure. He was resuscitated using advanced cardiac life support and intensive care. However, he remained unconscious despite target temperature management. Second-degree chemical burns were found on 10% of his total body surface area. Brain magnetic resonance imaging showed severe anoxic-ischemic encephalopathy involving bilateral supratentorial grey matter. TMAH was detected in the patient’ s blood and urine. To the best of our knowledge, this is the first report of the identification of TMAH in the serum and urine after exposure to the agent. Previous cases of cardiac arrest reported were due to exposure to high concentrations of 25% TMAH. We postulate that even low concentrations of TMAH could be absorbed rapidly after dermal exposure and can have fatal consequences.