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Lessons to be learned: a case study approach. Finger discoloration due to silver nitrate exposure: review of uses and toxicity of silver in clinical practice.

A 29 year-old lady attended the Accident and Emergency Department of a District General Hospital complaining of increasing black discoloration of the tip of her left middle finger; the appearance resembled that of gangrene. However, it was established that she had been applying silver nitrate to her finger, as prescribed by her general practitioner for the treatment of a small granuloma. Hence, the true diagnosis was of localised tissue necrosis, secondary to application of the silver nitrate sticks. On early discontinuation of the therapy, there was complete recovery. In consequence, it is recommended that the practice of unsupervised local application of silver nitrate to the fingers should be discontinued. Opportunity is taken herein to review the uses of silver nitrate in clinical situations--and of silver in any of its many other forms--together with their respective adverse effects.

Adult↗

Iatrogenic ocular silver nitrate burn.

Two cases of silver nitrate burn occurred after treatment of superior limbic keratoconjunctivitis with a solid silver nitrate applicator. After medical treatment and several months of observation, visual acuity eventually returned to acceptable levels with minimal corneal scarring. These cases emphasize the fact that silver nitrate should be used very cautiously around the eye and only in a fresh 0.5-1% solution. The use of solid silver nitrate should be prohibited around the eye.

Adult↗

Tetracycline versus silver nitrate pleurodesis in spontaneous pneumothorax.

Silver nitrate pleurodesis as prevention against recurrence in primary spontaneous pneumothorax was started in our department on an empiric basis. In a controlled trial in 1981 the method was found to be as good as earlier stated, but the method has a high number of side effects and has never been widely accepted. In a prospective, controlled trial comparing silver nitrate pleurodesis with tetracycline pleurodesis, we found no differences in recurrence frequency, but the time of hospitalization was significantly longer in the silver nitrate group (p less than 0.05). Furthermore, we found a decrease of exudation and a decreased use of analgetics in the tetracycline group. As a consequence of the investigation, we have abandoned the silver nitrate method and now recommend tetracycline pleurodesis as the treatment of choice in primary spontaneous pneumothorax in patients with only tiny blebs on the surface of the lung.

Adolescent↗

Antibacterial activity of Actisorb Plus, Actisorb and silver nitrate.

Activated Charcoal Cloth with silver (Actisorb Plus) and solutions of silver nitrate, but not Actisorb (Activated Charcoal Cloth without silver), demonstrated antibacterial activity against Gram-negative and Gram-positive bacteria. This activity was unimpaired in the presence of plasma. Sodium thioglycollate was an effective neutralizer of Actisorb Plus and of silver nitrate, indicating that the release of silver from Actisorb Plus contributed to the antibacterial activity of the dressing.

Charcoal↗

Mechanism of growth of colloidal silver nanoparticles stabilized by polyvinyl pyrrolidone in gamma-irradiated silver nitrate solution.

Silver nanoparticles were prepared by using polyvinyl pyrrolidone (PVP) as a stabilizer and gamma-irradiation. Transmission electron microscopy (TEM) results showed that both the amount and the molecular weight of PVP in the irradiated solution considerably affect the average size of the silver nanoparticles. The average size of the silver nanoparticles decreases with increasing the amount of PVP in the solution, but increases with increasing its molecular weight. Further, TEM showed that the silver nanoparticles become disassembled into smaller nanoparticles after dilution with distilled water and sonication. Since the processes of dilution and sonication are not expected to result in chemical reactions or to split the silver nanoparticles, we conclude that each silver nanoparticle prepared by [Formula: see text] -irradiation consists of several smaller nanoparticles surrounded by PVP. Thus, based on these observations, we propose a three-step mechanism for the growth of the silver nanoparticles under the conditions considered here. In the first step, the silver ions interact with PVP, then in the second step the silver ions that are exposed to gamma-irradiation are reduced to silver atoms; nearby silver atoms then aggregate at close range. These aggregates are the primary nanoparticles. Finally, these primary nanoparticles coalesce with other nearby primary nanoparticles or interact with PVP to form larger aggregates which are the secondary (final) nanoparticles.

Journal Article↗

Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum. A comparison of silver nitrate and tetracycline.

We evaluated the use of silver nitrate drops and tetracycline ointment for the prophylaxis of ophthalmia neonatorum in a controlled trial involving 2732 newborns in Nairobi, Kenya. The overall rates of prevalence of intrapartum maternal gonococcal and chlamydial infection were 6.4 and 8.9 percent, respectively. After prophylaxis with silver nitrate, the incidence rates of gonococcal, chlamydial, and nongonococcal, nonchlamydial ophthalmia neonatorum were 0.4, 0.7, and 6.2 percent, respectively, whereas after prophylaxis with tetracycline, the rates were 0.1, 0.5, and 4.5 percent. The attack rates of gonococcal ophthalmia neonatorum in newborns exposed to Neisseria gonorrhoeae at birth were 7.0 percent in those receiving silver nitrate and 3.0 percent in those receiving tetracycline (95 percent confidence interval for the difference in rates, -3.4 to 11.4 percent). As compared with historical controls, the incidence of gonococcal ophthalmia neonatorum decreased 83 percent among infants treated with silver nitrate and 93 percent among those treated with tetracycline. Failure of prophylaxis was associated with postpartum maternal endometritis (P = 0.05). Among newborns exposed to maternal infection with Chlamydia trachomatis, chlamydial conjunctivitis developed in 10.1 percent given silver nitrate and in 7.2 percent given tetracycline (95 percent confidence interval for the difference in rates, -4.7 to 10.5 percent), yielding reductions in the incidence of chlamydial ophthalmia of 68 and 77 percent, respectively, as compared with the historical controls. We conclude that tetracycline is as effective as silver nitrate in preventing gonococcal ophthalmia neonatorum.

Chlamydia Infections↗

Argyremia in septal cauterization with silver nitrate.

OBJECTIVE: The purpose of this study was to demonstrate silver absorption in blood and hair specimens after septal cauterization with silver nitrate and to discuss the potential toxicity of silver. METHOD: A prospective study of 11 volunteers without any known occupational exposure to silver products or past history of septal cauterization with silver nitrate was undertaken. Subjects were recruited in an academic tertiary care centre from October 1996 to September 1997. The study population consisted of five patients with anterior epistaxis and six healthy volunteers without any bleeding problem. Cauterization was done with one or two silver nitrate applicators directly on the bleeding vessel or Kiesselbach's area. Blood was sampled before cauterization and at specified times after application, while hair strands were sampled only 3 months later. Measurements of silver concentration in whole blood and in hair segments were obtained by inductively coupled plasma mass spectrometry. RESULTS: Silver concentrations in whole blood increased significantly after cauterization (p = .02). The measured peak level seemed to correlate with the number of applicators used. No significant increase in silver concentration was observed in hair samples. CONCLUSIONS: Effective silver absorption occurs with only one or two silver nitrate applicators. Hair has not been as reliable as whole blood to document an acute and fragmentary exposure. The indiscriminate use of silver nitrate is a potential source of silver intoxication.

Absorption↗

The colors of silver with silver nitrate staining in dental materials.

Silver nitrate has been used as a stain to study the permeability, degradation, and marginal integrity of dental composite restorations. The reagent results in various colors in the composite or marginal interface. So that the cause of these colors could be investigated, this study compared the appearances of the stained layers by light and electron microscopy. The results indicated that the colors could be explained by the distribution of silver particles ranging from minute colloidal particles (20 nm) in the composite or dentin, to clusters of large particles (0.1-1 micron) in marginal interfaces. The colors can be explained by the absorption and scattering of light by these particles. At elevated temperatures, fused concretions of silver formed in the composite subsurface, resulting in direct reflection of incident light. The colors which appear with silver nitrate staining may indicate the size and distribution of microporosity in the material.

Color↗

Control of prolonged, benign, renal hematuria by silver nitrate instillation.

Four patients with protracted benign hematuria underwent silver nitrate instillation of the upper collecting system. The doses varied from 10 ml. of 0.25 per cent silver nitrate to 14 ml. of 1 per cent silver nitrate. In all 4 cases the hematuria resolved within four days without significant complications. At follow-up extending from three to twenty-four months there have been no recurrences of gross hematuria. Silver nitrate instillation appears to be a safe and effective method of treating benign renal hematuria, thus obviating the need for extirpative surgery.

Adult↗

Experimental pleurodesis in rabbits induced by silver nitrate or talc: 1-year follow-up.

STUDY OBJECTIVE: To compare the pleurodesis results from the intrapleural injection of silver nitrate and talc slurry over an observation period of 12 months in rabbits. DESIGN: Rabbits were randomized to receive 2 mL of 0.5% silver nitrate or 400 mg/kg of talc slurry in 2 mL intrapleurally. Ten rabbits in each group were killed at 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, and 12 months after intrapleural injection. The degree of gross pleurodesis and the amount of microscopic pleural fibrosis and inflammation were graded on a scale of 0 to 4. RESULTS: The mean +/- SEM gross pleurodesis score in the 70 rabbits that received silver nitrate was 3.34 +/- 0.08, which was significantly higher than the score of 2.32 +/- 0.09 in the 70 rabbits that received talc. The mean gross pleurodesis score was significantly higher at each of the observation times (p < 0.05), except at 2 months, in the rabbits that received silver nitrate. The pleurodesis was distributed throughout the thorax in the rabbits that received silver nitrate, while it was only in the ventral thorax in the rabbits that received talc slurry. The gross pleurodesis scores showed no tendency to decrease during the 12-month observation period in either treatment group. The persistence of talc in the pleural space did not lead to chronic inflammatory changes because the inflammation scores were similar in both groups at all observation times. The microscopic pleural fibrosis score tended to decrease with time in the silver nitrate group but not in the talc slurry group. CONCLUSIONS: The intrapleural injection of 2 mL of 0.5% silver nitrate produces a better pleurodesis than does the intrapleural injection of 400 mg/kg of talc slurry in rabbits. The pleurodesis induced by silver nitrate persists for at least 1 year. The efficacy of silver nitrate as a sclerosing agent in humans should be evaluated.

Animals↗

An investigation into the permeability of composite materials using silver nitrate.

A new effect of silver-nitrate staining on dental composites and unfilled polymers has been observed which may be useful in the study of polymer permeability. After extended storage in silver nitrate, the materials developed a layer of brown stain in the subsurface. The color was thought to be caused by the presence of finely divided silver precipitated in microcavities within the composite. Energy Dispersive Analysis by x-ray confirmed the presence of silver in the stained zone. The width and shade of staining varied in different materials. After 90 days, layers of different shades could be seen within the stained zone. The exact shade of the stain is thought to depend upon the size of the precipitated silver particles, which is directly related to the sizes of the microcavities.

Absorption↗

Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times.

Silver nitrate is used extensively in rhinological practice for the treatment of recurrent epistaxis. There are currently no recommendations in the literature regarding the optimum application time of this chemical for effective treatment. We assessed the histological effects of silver nitrate on mucosal tissue at varying contact times and made recommendations based on our findings. Silver nitrate was applied at predetermined contact times to tonsillar mucosa, immediately before tonsillectomy in subjects undergoing routine surgery. The cauterized areas were subsequently analysed histologically. The depth of tissue penetration by the silver nitrate was measured. The means for 5, 10 and 20 s were 0.44, 0.30 and 0.38, respectively, P = 0.3. Overall, there was no deeper penetration of the tissues with contact times over 5 s. We conclude that it is not necessary to apply silver nitrate for greater than 5 s to achieve maximal tissue penetration.

Anti-Infective Agents, Local↗