What are the side effects of using silver nitrate?

Side Effects of Silver Nitrate

Silver nitrate can cause skin staining, hypocalcemia from systemic absorption, and argyria (permanent gray-blue discoloration of skin or mucous membranes) with excessive use or prolonged exposure. 1, 2, 3

Common Side Effects

• Skin and tissue staining: Silver nitrate causes transient to permanent staining of skin, clothing, and other materials it contacts 4, 2
• Irritation: Caustic and irritating to skin and mucous membranes 4
• Pain: Local discomfort at application site

Serious Side Effects

• Argyria: Permanent gray-blue discoloration of skin and mucous membranes from silver deposition in tissues 5, 3

  • Can be localized or generalized depending on exposure
  • Irreversible once developed
  • Risk increases with:
    • Prolonged use
    • Application to large surface areas
    • Application to mucous membranes

• Systemic toxicity:

  • Hypocalcemia: Due to systemic absorption, especially when applied to large areas 1
  • Gastrointestinal toxicity: If ingested, can cause severe gastroenteritis that may be fatal 4
  • Central nervous system toxicity: If ingested 4

Ocular Side Effects

• When used as eye drops or for ophthalmia neonatorum prophylaxis:
  • Ocular argyrosis (silver deposition in eye tissues) 6
  • Potential visual disturbances with long-term exposure 6

Risk Factors for Complications

• Large surface area application
• Prolonged or repeated applications
• Application to highly vascular tissue
• Pre-existing renal impairment
• Electrolyte abnormalities 1

Precautions for Use

1. Handle carefully to avoid staining skin, clothing, and surfaces 4
2. For external use only
3. Store at 20° to 25°C (68° to 77°F)
4. Protect from light
5. Keep out of reach of children 4

Management of Complications

• For ingestion: Gastric lavage with sodium chloride solution 4
• For hypocalcemia:
  • Discontinue silver nitrate application
  • Administer calcium supplementation
  • Monitor electrolytes until normalized 1
• For skin staining: May be temporary with limited exposure but can become permanent with repeated use

Clinical Applications

Despite these side effects, silver nitrate remains useful in specific clinical scenarios:

• Treatment of hypergranulation tissue 7, 1
• Management of fissures 7
• Treatment of low-lying perianal fistulas 8
• Prophylaxis for ophthalmia neonatorum in newborns 7

When using silver nitrate, limit exposure to the minimum effective concentration and duration to minimize risk of complications 1.