Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: A burn center's experience

ABSTRACT In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complicatio...

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Published in:	Wound repair and regeneration Vol. 19; no. 2; pp. 201 - 204
Main Authors:	Kath, Melissa A., Shupp, Jeffrey W., Matt, Sarah E., Shaw, Jesse D., Johnson, Laura S., Pavlovich, Anna R., Brant, Jennifer D., Mete, Mihriye, Jeng, James C., Jordan, Marion H.
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01-03-2011
Subjects:	Adolescent Adult Aged Aged, 80 and over Anti-Infective Agents, Local - adverse effects Anti-Infective Agents, Local - therapeutic use Burns - drug therapy Cerium - adverse effects Cerium - therapeutic use Humans Methemoglobin - analysis Methemoglobinemia - chemically induced Methemoglobinemia - diagnosis Middle Aged Silver Sulfadiazine - adverse effects Silver Sulfadiazine - therapeutic use Young Adult
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Summary:	ABSTRACT In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complication of this treatment is the development of methemoglobinemia (Met‐Hba) due to the oxidizing nature of Ce(NO3)3. Met‐Hba has a spectrum of clinical consequences, ranging from headache and cyanosis to cardiac ischemia, hypotension, and even death. Given the frequent use of this combination agent at our burn center, a retrospective review was conducted to evaluate the incidence of Met‐Hba. A query of pharmacy records revealed 170 patients from January 2005 to October 2009 that had received this treatment. Eighteen patients (∼10%) developed Met‐Hba as noted on arterial blood gas (methemoglobin>3%) and only three patients (∼2%) had methemoglobin levels >10%. In the majority of cases, there were no clinical symptoms of Met‐Hba. Most patients' relative hypoxia resolved with cessation of treatment; however, five patients required treatment with methylene blue. The presence of Met‐Hba associated with this topical therapy can be diagnosed early by vigilant monitoring, thereby reducing morbidity and mortality. In our experience, cerium combined with silver sulfadiazine is a valuable and safe treatment for deep partial and full‐thickness burn wounds.
Bibliography:	ArticleID:WRR665 ark:/67375/WNG-KP5TDF6W-4 istex:C3C79CDA2BA3846AFA776E72F8C53142ECB02FBE ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1067-1927 1524-475X
DOI:	10.1111/j.1524-475X.2010.00665.x