title: Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: a burn center's experience.
abstract: In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complication of this treatment is the development of methemoglobinemia (Met-Hba) due to the oxidizing nature of Ce(NO(3))(3). Met-Hba has a spectrum of clinical consequences, ranging from headache and cyanosis to cardiac ischemia, hypotension, and even death. Given the frequent use of this combination agent at our burn center, a retrospective review was conducted to evaluate the incidence of Met-Hba. A query of pharmacy records revealed 170 patients from January 2005 to October 2009 that had received this treatment. Eighteen patients (∼10%) developed Met-Hba as noted on arterial blood gas (methemoglobin>3%) and only three patients (∼2%) had methemoglobin levels >10%. In the majority of cases, there were no clinical symptoms of Met-Hba. Most patients' relative hypoxia resolved with cessation of treatment; however, five patients required treatment with methylene blue. The presence of Met-Hba associated with this topical therapy can be diagnosed early by vigilant monitoring, thereby reducing morbidity and mortality. In our experience, cerium combined with silver sulfadiazine is a valuable and safe treatment for deep partial and full-thickness burn wounds.
authors.affiliation: The Burn Center, Department of Surgery, Washington Hospital Center, Washington, District of Columbia 20010, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Kath
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Shupp
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Matt
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Shaw
authors.forename: Laura S
authors.initials: LS
authors.lastname: Johnson
authors.forename: Anna R
authors.initials: AR
authors.lastname: Pavlovich
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Brant
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.forename: James C
authors.initials: JC
authors.lastname: Jeng
authors.forename: Marion H
authors.initials: MH
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects* / Q000627:therapeutic use; D002056:Burns / Q000188:drug therapy*; D002563:Cerium / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008706:Methemoglobin / Q000032:analysis; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D012837:Silver Sulfadiazine / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; C032786:cerium nitrate; D002563:Cerium; D008706:Methemoglobin; D012837:Silver Sulfadiazine