氫氧化四甲基銨(TMAH)中毒

Tetramethylammonium Hydroxide Intoxication

吳政龍(Chen-Long Wu) ； 林宏榮(Hung-Jung Lin) ； 郭浩然(How-Ran Guo) ； 蘇世斌(Shih-Bin Su)

《中華職業醫學雜誌》 14卷2期 (2007/04) Pp. 67-76

https://doi.org/10.30027/CJOM.200704.0001

摘要

氫氧化四甲基銨(Tetramethylammonium hydroxide, TMAH)被廣泛運用在半導體及光電產業，但對人體的健康影響資料有限，近來台灣已有三例因皮膚暴露TMAH的致死案例。本文整理TMAH的解離產物TMA經口與皮膚暴露之臨床表現、致病機轉與急救措施進行文獻整理與討論。 過去文獻中的TMA中毒個案報告屈指可數，且多因誤食含有四甲基銨離子(tetramethylammonium ions, TMA)的腹足綱貝類造成。TMA在腸道可快速吸收，並主要經由腎臟排泄；過去則缺乏經皮吸收的資料。TMA被認為是擬膽鹼性作用劑(cholinergicagonist)，可引起神經細胞去極化阻斷(depolarization blockade)、骨骼肌鬆弛型麻痺(flaccid paralysis)與腺體分泌。食物中毒的臨床表現主要包括視覺障礙、肌肉無力及頭痛頭暈等症狀，常在誤食後數小時內發作，皮膚暴露個案則在一小時內死亡；臨床表現可由周邊菸鹼性及毒蕈鹼性作用解釋，是否影響中樞神經系統則尚未有定論。呼吸抑制被認為是TMA中毒的主要致死原因，但心臟功能的影響可能也會惡化呼吸衰竭。及早除污是現場急救第一要務，治療中毒病患時需密切觀察並維持呼吸與心臟功能。目前缺乏解毒劑的使用資料。 皮膚暴露TMAH足以致命，但目前仍缺乏相關毒理研究。建議相關職場工安衛生人員及急救醫師應注意高科技產業中可能的TMAH暴露。

關鍵字

氫氧化四甲基銨 ； 皮膚暴露 ； 四甲基銨離子 ； 擬膽鹼性作用劑 ； 呼吸抑制

並列摘要

Tetramethylammonium hydroxide (TMAH) is widely used in the semiconductor and liquid crystal display (LCD) industries nowadays, but information regarding its effects on human health is limited. There were three mortalities of dermal exposure to TMAH at work in Taiwan in recent years. This review collected and discussed the references of TMA intoxication focused on the clinical presentations, mechanisms, and emergency managements especially for dermal exposure and ingestion.
Only a few reports of intoxication are available, and they are on cases from eating food, mostly gastropods, containing tetramethylammonium ions (TMA). TMA was absorbed near completely in the gastrointestinal tract, and mainly excreted by kidney. There was no available data for the dermal absorption of TMA. As a cholinergic agonist agent, TMA can induce depolarization blockade in the nervous system, lead to flaccid paralysis of skeletal muscles, and stimulate secretion of glands. For food intoxication, the most clinical presentations included vision deteriorations, muscle weakness, headache and dizziness. They usually initiated in several hours after oral intake. The three dermal exposed cases were all dead in one hour. They were related to nicotinic and muscarinic effects, but the CNS effects could not be ruled out. The inhibition of respiratory may cause mortality in exposed workers and alternation of cardiac function would facilitate the mortality. Early decontamination is the most important first aid procedure; respiratory and cardiac functions should be closely monitored and maintained in treating the exposed patients. Specific antidote need further research and develop.
Whereas few toxicological data were found in the literature, dermal exposure to TMAH can be fatal. Industrial hygienists and physicians should be aware of the potential occupational and environmental exposures.

並列關鍵字

Tetramethylammonium hydroxide ； dermal exposure ； Tetramethylammonium ions ； cholinergic agonist ； inhibition of respiratory