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Informational/Educational Report
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Silver safety Adrian Keene, BS, Smith & Nephew Wound Management, Hull, UK The safety issues surrounding the use of silver in woundcare can be confusing for the healthcare professional. This review of existing literature on the toxicity of silver and silver compounds was undertaken to more precisely differentiate the effects of silver from the effects of associated moieties (eg, sulfadiazine) Silver exposure alone to an extent sufficient to produce argyrosis or argyria does not produce clinically observable renal or liver damage, neurological effects, hematology changes including cytopenias, or significant serum chemistry changes. Even in patients with very high levels of serum silver (300 µg/L) and marked deposition of silver in the liver following treatment with silver sulfadiazine (SSD), late hepatic dysfunction or multisystem failure does not occur. There also appears to be no correlation between serum silver levels and effects on renal function Although reversible neuropathy has been reported in some patients treated with SSD, such neuropathy is not reported for persons occupationally exposed to silver salts even with frank argyria or argyrosis. This suggests that these neuropathies are due to the sulfadiazine component of SSD as opposed to being an effect of silver itself Other effects reported in silver sulfadiazine treated patients (transient cytopenias) are due to sulfadiazine in some instances, or is a result of the physiological damage from the burns While it has been suggested that a pre-existing renal function impairment may produce a higher serum silver level in SSD treated burn patients the literature does not support such an association Although argyria can occur following prolonged exposure to higher levels of silver, it is generally considered a cosmetic issue, and is not expected to produce effects of long term clinical significance Accordingly the risk of induction or either argyria or other toxic effects in patients as a result of the use of silver containing wound dressings is low. |
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