Respiratory Arrest due to Muscle Paralysis Caused by Mono, Bis- (Trimethylammoniummethylene Chloride) -Alkyl-Toluene Injection: A Case Report

Abstract

Quaternary ammonium compounds are a large class of permanently charged cationic chemicals used in various consumer and industrial products owing to their antimicrobial properties; mono, bis- (trimethylammoniummethylene chloride) -alkyl-toluene (TAMCA) exhibits bactericidal activity by denaturing the proteins in the bacterial membrane when the cations in its structure are adsorbed to the anionic structure on the bacterial surface. Here, we report the first case of respiratory arrest due to muscle paralysis caused by subcutaneous injection of TAMCA. A 26-year-old man accidently injected with the aforementioned compound, developed respiratory arrest after approximately 1 h. We diagnosed him with TAMCA-related toxicosis. We successfully treated him by ventilatory management followed by tracheal intubation by injecting 10 mL of 1% propofol (100 mg), as he resumed spontaneous breathing the next day, about 15 h following the incident. Subsequently, he developed necrotizing soft tissue and underwent debridement and skin grafting surgery. This case demonstrated that TAMCA erroneous subcutaneous injection or administration into the human body may induce respiratory muscle paralysis thereby necessitating prompt treatment.