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The Journal of the Royal Society for the Promotion of Health
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Lessons to be learned: a case study approach Finger discoloration due to silver nitrate exposure

review of uses and toxicity of silver in clinical practice

Nagamanickam Sai Sankar, MB, BS, FRCS

Trust Practitioner Orthopaedics Department Crawley Hospital Crawley West Sussex

David Donaldson, MB, ChB, MRCP, FRCPath

Consultant Chemical Pathologist East Surrey Hospital Redhill Surrey and Crawley Hospital Crawley West Sussex

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

Key Words: Adverse effects • argyria • finger discoloration • silver • silver nitrate

The Journal of the Royal Society for the Promotion of Health, Vol. 118, No. 6, 371-374 (1998)
DOI: 10.1177/146642409811800618
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