ELIMINATION STUDY OF SILVER IN A HEMODIALYZED BURN PATIENT TREATED WITH SILVER SULFADIAZINE CREAM

Silver sulfadiazine (SSD) cream is a potent agent for the treatment of burns, In a patient with end-stage renal disease, we observed a marke d elevation in serum silver concentration in the course of 2 weeks of SSD cream therapy (200 g/d), Serum concentration of silver reached a m aximum of 291 ng/mL in association with a rapid deterioration of menta l status. SSD therapy was discontinued, and hemodialysis, hemofiltrati on, or plasma exchange was continually performed, Four months later, t he patient died. At autopsy, profoundly elevated levels of silver were found in brain tissues of this patient (617.3, 823.7 ng/g wet tissue weight in the cerebrum and cerebellum, respectively). To determine the most efficient therapy to remove silver from serum, we compared hemod ialysis (HD), hemofiltration (HF), and plasma exchange (PE). Both plas ma exchange and hemofiltration were effective in decreasing serum silv er, and their effects were additive. By contrast, HD was ineffective i n reducing serum silver. This case illustrates that, on SSD cream ther apy, burn patients with disturbed renal function are at risk of accumu lating silver in serum and tissue to the level that may cause neuralgi c decompensation. Removal of serum sliver can best be effected by PE, particularly when combined with HF. In contrast, HD per se does not ap pear efficacious, None of these blood purification modalities improves deterioration of neurological status potentially attributable to silv er deposition in brain tissues. (C) 1997 by the National Kidney Founda tion, Inc.