Trifluoroacetic acid: Three times the fluoride, three times the toxicity?

Trifluoroacetic acid (TFAA) is a carboxylic acid, similar to acetic acid, used industrially and in laboratories. There is a paucity of data regarding exposure and the concern is that toxicity may mimic that of hydrofluoric acid (HF), causing electrolyte abnormalities, dysrhythmia, and cardiac arrest. We report a case of a 27-year-old male that presents with a dermal exposure to TFAA. His exam was remarkable for a 4% body surface area partial thickness burn to the right forearm. There were no initial electrolyte abnormalities or dysrhythmias and the patient was admitted to telemetry monitoring overnight. Serial laboratories were normal, dysrhythmias did not occur, and patient was ultimately discharged with routine burn care of the wound. Previously reported TFAA exposures are uncommon and tend to be very small body surface area chemical burns without clear systemic toxicity. HF as well as sodium and ammonium bifluorides have been shown to cause clinically significant electrolyte disturbances that can lead to dysrhythmias and fatalities. While TFAA may be structurally similar, it does not appear to have similar toxicity. This is an important difference in presentation and treatment that emergency physicians should be aware of as occupational exposures are likely to present to the emergency department.