Determination of silver in blood, urine, and tissues of volunteers and burn patients

Abstract

Silver sulfadiazine cream (SSD) has been used successfully in the management of burn wound sepsis. Silver deposition has been found in the skin, gingiva, cornea, liver, and kidney of patients treated with this cream, causing argyria, ocular injury, leukopenia, and toxicity in kidney, liver, and neurologic tissues. Monitoring concentrations of silver in blood and urine of patients receiving this treatment has become necessary, but sensitive and suitable methods adaptable to a clinical laboratory are still needed. We have developed a flameless thermal atomic absorption spectrophotometric method to measure silver concentrations in blood, urine, and other tissues. The detection limit is 0.4 microgram/L; the within-run precisions (CV) are 5.16%, 3.83%, and 2.79% for concentrations of 5, 13.5, and 42 micrograms/L, respectively; and the between-run precisions are 4.3% and 3.2% for concentrations of 13.5 and 42 micrograms/L. The concentrations of silver in blood, urine, liver, and kidney of subjects without industrial or medicinal exposure are less than 2.3 micrograms/L, 2 micrograms/day, 0.05 microgram/g wet tissue, and 0.05 microgram/g wet tissue, respectively. In SSD cream-treated burn patients, plasma concentrations may be as great as 50 micrograms/L within 6 h of treatment and can reach a maximum of 310 micrograms/L. Silver in urine is detectable after one day of treatment and may reach a maximum of 400 micrograms/day. After absorption, silver was found to be deposited in various tissues. Tissue silver concentrations in one burn patient who died of renal failure after eight days of treatment were 970, 14, and 0.2 micrograms/g wet tissue in cornea, liver, and kidney, respectively.

Transdermal uptake and organ distribution of silver from two different wound dressings in rats after a burn trauma

“…In one patient, a postmortem examination after the use of SSD revealed elevated silver levels in the liver, kidney, and cornea. 19 Another patient with 30% BSA burn reported by Iwasaki et al had markedly elevated silver levels in the brain (617.3 ng/g wet weight) after application of SSD and end-stage kidney disease. 24 We did not investigate SSD as wound treatment in our study because the pharmaceutical form of SSD as a 1% cream for external use needed daily dressing changes that could not be provided by our study group long term over 6 weeks.…”

“…18 Various reports describe the uptake of externally applied silver, mainly silver sulfadiazine (SSD), into the blood in burn patients. 19,20 However, studies on silver levels of different organs and tissues after external application of silvercontaining wound dressings after major burns are scarce. A recent study from Brandt et al reports elevated silver levels in different organs, blood, and feces in hairless mice, externally treated with different silver formulations.…”

Percutaneous absorption in diseased skin: an overview

“…Such absorption may lead to hypersensitivity reactions, such as neutropenia and erythema multiforme (Lockhart et al, 1983). Wan et al (1991) determined that urinary excretion of silver and silver concentrations in plasma increased with the application of a standard solution of silver containing AgNO 3 . Balogh et al (1985) found in an in vivo study that the application of povidone-iodine resulted in higher iodine levels in the plasma and higher iodine excretion in the urine of burn patients than traumatized patients.…”

Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds

“…The multivariate analysis showed that anaemia was a risk factor for increased serum silver at D28 (OR = 5.33 [1. [14][15][16][17][18][19][20][21][22][23][24].90] P = 0.033) and that a higher albumin serum was protective for increased serum silver at D28 (OR = 0.844 [0.73-0.98] P = 0.029). Indeed, each increase in the sera albumin dosage of 1 g/L diminished the risk of increased serum silver.…”

“…The dressings involved in these studies were SSD and Acticoat TM . [18][19][20][21][22] Moreover, Karlmarsk et al's study showed that silver absorption tended to be higher in patients with larger venous ulcers. 15 In our study, the highest observed silver level was 14.2 lg/L, which is much higher than detected in previous studies (<8.6 lg/L).…”