High Serum Levels of Silver in a Paediatric Burns Patient Managed with Silver Dressings Does Not Equate to a Clinical Disaster

Dr Ingrid Salna1, Dr Edward Gibson2, Dr Lachlan Farmer2, Dr  Bernard Carney2

1Royal Adelaide Hospital, Glandore, Australia, 2Women’s & Children’s Hospital, North Adelaide, Australian


Silver ion has been employed as an antimicrobial for several millennia and, in burn wound care, for over 200 years. Since the 1960s, silver dressings have become the mainstay in burns dressings in an adult population and proven safe in long-term use. Argyria is a feared condition caused by excessive exposure to silver compounds. Silver dressings are thus used cautiously in the paediatric population, who have nearly three times the body surface area to body mass ratio of adults. However, adverse effects are almost always related to inappropriate use, such as oral ingestion of colloidal silver solutions. This is a case report of serial silver dressings in a young boy that led to high levels of serum silver and a review of the literature. He had no significant clinical findings or adverse outcomes and once the dressing regime was changed, his serum levels normalised relatively quickly. On review of the literature, overall silver dressings: were cost effective, reduce burn wound incidence, decrease pain levels during dressing changes, decrease the frequency of dressing changes, decrease the matrix metalloproteinase activity, reduces the wound exudate and bioburden levels, and promotes wound healing in chronic wounds. There is no in vivo evidence to suggest that nanocrystalline silver is toxic to skin cells such as keratinocytes and fibroblasts. The purpose of this is to highlight the safety of silver dressings and reiterate their role in burns care in paeditric patients.


Dr Ingrid Salna is a current Unaccredited Plastic & Reconstructive Surgery Registrar at the Royal Adelaide Hospital. She has successfully completed an undergraduate degree including a Health Science Honours and subsequently a Doctor of Medicine at Flinders University in 2013. She has since been working in the Central Adelaide Local Health Network as a surgical medical officer and registrar in both general and plastic surgery, and has ongoing interests in multiple fields of Plastic & Reconstructive Surgery research.

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