Silver-coated dressing acticoat caused raised liver enzymes and argyria-like symptoms in burn patient.
BACKGROUND
Treatment of acute burn wounds with silver sulfadiazine (SSD) has raised concern about potential silver toxicity. Numerous adverse reactions and side effects have been reported and an increasing resistance to SSD, especially in Pseudomonas strains, have motivated researchers to search for an alternative wound dressing.


METHODS
Recently, a silver-coated wound dressing Acticoat (Smith & Nephew, Inc.) has become available for use in burn patients. It is a three-ply dressing, consisting of an inner rayon/polyester absorptive core between two layers of silver-coated, high-density polyethylene mesh. In a moist environment, the nanocrystals of silver are released and improve the microbial control in the wound.


RESULTS
After 1 week of local treatment with Acticoat in a young, previously healthy 17-year-old boy with 30% mixed depth burns, hepatotoxicity and argyria-like symptoms, a grayish discoloration of the patient's face, appeared. The silver levels in plasma (107 microg/kg) and urine (28 microg/kg) were clearly elevated, as well as the liver enzymes. As soon as the local application of Acticoat was aborted, the clinical symptoms and liver enzymes returned to the normal values.


CONCLUSIONS
This is the first report on silver toxicity in a patient with 30% burns who received Acticoat for local treatment. Due to substantial experiences with adverse SSD reactions and side effects, it is appropriate to keep the possibility of a toxic silver effect in burn patients treated with Acticoat silver-coated wound dressing in mind. The silver levels in plasma and/or urine should be monitored.
Department of Paediatrics, Children's Burns Unit, and the Institute of Chemistry, Analytical Chemistry, Medical University of Graz, Graz, Austria. marija.trop@meduni-graz.at
Marija
M
Trop
Michael
M
Novak
Siegfried
S
Rodl
Bengt
B
Hellbom
Wolfgang
W
Kroell
Walter
W
Goessler
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D000891:Anti-Infective Agents, Local / Q000633:toxicity*; D001129:Argyria / Q000175:diagnosis / Q000209:etiology*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001458:Bandages; D002056:Burns / Q000628:therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D012834:Silver / Q000493:pharmacokinetics; D012837:Silver Sulfadiazine / Q000633:toxicity*; D005723:gamma-Glutamyltransferase / Q000097:blood*
D000891:Anti-Infective Agents, Local; D012834:Silver; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D012837:Silver Sulfadiazine