Dermal exposure to tetramethylammonium hydroxide (TMAH) can lead to rapid respiratory failure and death. What factors associated with dermal exposure increase this risk?
Cases in which patients are exposed to higher concentration products (25% TMAH), when larger body surface areas are exposed, or when patients have second- or third-degree burns are associated with more severe toxicity. The dermal absorption of TMA+ (tetramethylammonium ion) is minimal due to its hydrophilicity, but absorption can become significant in cases where the skin integrity is compromised. The TMA+ acts as a cholinergic agonist and can lead to rapid weakness, salivation, shortness of breath, and in severe cases respiratory compromise, paralysis, and death.
Huang C-K et al. Presentations of tetramethylammonium hydroxide dermal exposure and the valuable potential of diphoterine solution in decontamination: a retrospective observational study. BMC Pharmacology and Toxicology. 2020; 21:83. https://doi.org/10.1186/s40360-020-00465-8