Argyremia in septal cauterization with silver nitrate

Objective: The purpose of this study was to demonstrate silver absorption i n blood and hair specimens after septal cauterization with silver nitrate a nd to discuss the potential toxicity of: silver. Method: A prospective study of II volunteers without any known occupational exposure to silver products or past history of septal cauterization with s ilver nitrate was undertaken. Subjects were recruited in an academic tertia ry care centre from October 1996 to September 1997. The study population co nsisted of five patients with anterior epistaxis and six healthy volunteers without any bleeding problem. Cauterization was done with one or two silve r nitrate applicators directly on the bleeding vessel or Kiesselbach's area . Blood was sampled before cauterization and at specified times after appli cation, while hair strands were sampled only 3 months later. Measurements o f 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 lever seemed to correlate with the number of applicators used. No significant increase in silver concentra tion 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 docum ent an acute and fragmentary exposure. The indiscriminate use of silver nit rate is a potential source of silver intoxication.