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

• 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
• ISSN: 1067-1927; 1524-475X
• DOI: 10.1111/j.1524-475X.2010.00665.x

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.