Lessons to be learned: a case study approach - Finger discoloration due tosilver nitrate exposure: review of uses and toxicity of silver in clinicalpractice

A 29 year-old lady attended the Accident and Emergency Department of a Dist rict General Hospital complaining of increasing black discoloration of the tip of her left middle finger; the appearance resembled that of gangrene. H owever, it was established that she had been applying silver nitrate to her finger as prescribed by her general practitioner for the treatment of a sm all granuloma. Hence, the true diagnosis was of localised tissue necrosis, secondary to application of the silver nitrate sticks. On early discontinua tion of the therapy, there was complete recovery. In consequence, it is rec ommended that the practice of unsupervised local application of silver nitr ate to the fingers should be discontinued. Opportunity is taken herein to r eview the uses of silver nitrate in clinical situations - and of silver in any of its many other forms - together with their respective adverse effect s.