136 lines
69 KiB
Text
136 lines
69 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-part">
|
|
<meta name="ncbi_acc" content="NBK604211">
|
|
<meta name="ncbi_domain" content="statpearls">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK604211/?report=reader">
|
|
<meta name="ncbi_pagename" content="Silver Toxicity - StatPearls - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="chapter">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Silver Toxicity - StatPearls - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="auto">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="citation_inbook_title" content="StatPearls [Internet]">
|
|
<meta name="citation_title" content="Silver Toxicity">
|
|
<meta name="citation_publisher" content="StatPearls Publishing">
|
|
<meta name="citation_date" content="2024/10/28">
|
|
<meta name="citation_author" content="Matthew B. Steck">
|
|
<meta name="citation_author" content="Brian P. Murray">
|
|
<meta name="citation_pmid" content="38861631">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK604211/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Silver Toxicity">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="StatPearls Publishing">
|
|
<meta name="DC.Contributor" content="Matthew B. Steck">
|
|
<meta name="DC.Contributor" content="Brian P. Murray">
|
|
<meta name="DC.Date" content="2024/10/28">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK604211/">
|
|
<meta name="description" content="Silver is a soft metal that is not essential for biological processes. This metal has the best electrical and thermal conductivity and reflectivity compared to all other metals.[1] These properties provide a wide variety of uses and applications in society. Human exposure to silver has occurred for centuries, dating back to ancient civilizations. Exposures to silver occur through industry, occupational exposure, medications, and health and nutritional supplements. Repeated or prolonged exposure to silver can lead to silver toxicity, with the most common health effect being irreversibly localized and generalized blue to slate-gray skin pigmentation secondary to silver deposition called argyria.[2] The amount of silver in human tissues is low. However, overexposure can result in the accumulation of silver in the skin, liver, kidneys, mucous membranes, corneas, gingiva, spleen, and nails.[3]">
|
|
<meta name="og:title" content="Silver Toxicity">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="Silver is a soft metal that is not essential for biological processes. This metal has the best electrical and thermal conductivity and reflectivity compared to all other metals.[1] These properties provide a wide variety of uses and applications in society. Human exposure to silver has occurred for centuries, dating back to ancient civilizations. Exposures to silver occur through industry, occupational exposure, medications, and health and nutritional supplements. Repeated or prolonged exposure to silver can lead to silver toxicity, with the most common health effect being irreversibly localized and generalized blue to slate-gray skin pigmentation secondary to silver deposition called argyria.[2] The amount of silver in human tissues is low. However, overexposure can result in the accumulation of silver in the skin, liver, kidneys, mucous membranes, corneas, gingiva, spleen, and nails.[3]">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK604211/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/statpearls/article-165065/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK604211/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8B413F7C914A7100000000012200EB.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK604211/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Silver Toxicity</div><div class="j">StatPearls [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK604211/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK604211/&text=Silver%20Toxicity"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/statpearls/?report=reader">Title Information</a><a href="/books/n/statpearls/toc/?report=reader">Table of Contents Page</a><a href="#_NBK604211_">Silver Toxicity</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK604211/?report=classic">Switch to classic view</a><a href="/books/NBK604211/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK604211%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8B413F7C914A7100000000012200EB.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK604211_"><span class="title" itemprop="name">Silver Toxicity</span></h1><p class="contribs">Steck MB, Murray BP.</p><p class="fm-aai"><a href="#_NBK604211_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-165065.s1"><h2 id="_article-165065_s1_">Continuing Education Activity</h2><p>Silver toxicity is a rare diagnosis that typically manifests as cutaneous findings. Over time, the build-up of cutaneous silver deposits eventually leads to the development of a blue to slate-gray skin pigmentation called argyria. Argyria can be localized or generalized and, historically, is permanent. However, recent literature suggests that laser therapy modalities have shown promising results in addressing the cosmetic appearance of argyria. In addition to cutaneous manifestations, other complications have been documented in the literature. Silver toxicity can occur from various sources of exposure, including industrial and occupational settings, medical treatments, and the use of health and nutritional supplements. Mechanisms of exposure include ingestion, inhalation, and direct dermal contact.</p><p>This activity reviews the clinical presentation and pathophysiology of silver toxicity. Participating clinicians are equipped with the knowledge that members of an interprofessional care team need to identify and manage patients who present with this toxicity. Given the rarity, interprofessional collaboration is emphasized, leading to optimal differentiation from other types of metal toxicities.</p><p>
|
|
<b>Objectives:</b>
|
|
<ul><li class="half_rhythm"><div>Identify the etiology of silver toxicity based on patient history and physical examination.</div></li><li class="half_rhythm"><div>Compare the mechanisms of exposure to silver to rationalize short- and long-term treatment approaches.</div></li><li class="half_rhythm"><div>Differentiate early versus late-stage disease in patients presenting with silver toxicity.</div></li><li class="half_rhythm"><div>Coordinate with an interprofessional team to develop comprehensive treatment and management strategies for patients diagnosed with silver toxicity.</div></li></ul>
|
|
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=165065&utm_source=pubmed&utm_campaign=reviews&utm_content=165065" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
|
</p></div><div id="article-165065.s2"><h2 id="_article-165065_s2_">Introduction</h2><p>Silver is a soft metal that is not essential for biological processes. This metal has the best electrical and thermal conductivity and reflectivity compared to all other metals.<a class="bibr" href="#article-165065.r1" rid="article-165065.r1">[1]</a> These properties provide a wide variety of uses and applications in society. Human exposure to silver has occurred for centuries, dating back to ancient civilizations. Exposures to silver occur through industry, occupational exposure, medications, and health and nutritional supplements. Repeated or prolonged exposure to silver can lead to silver toxicity, with the most common health effect being irreversibly localized and generalized blue to slate-gray skin pigmentation secondary to silver deposition called argyria.<a class="bibr" href="#article-165065.r2" rid="article-165065.r2">[2]</a> The amount of silver in human tissues is low. However, overexposure can result in the accumulation of silver in the skin, liver, kidneys, mucous membranes, corneas, gingiva, spleen, and nails.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a></p></div><div id="article-165065.s3"><h2 id="_article-165065_s3_">Etiology</h2><p>Exposure to silver can occur through various mechanisms, including ingestion, inhalation, and dermal exposure.<a class="bibr" href="#article-165065.r1" rid="article-165065.r1">[1]</a><a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a></p><p>
|
|
<b>Common Products Containing Silver</b>
|
|
</p><p>Silver compounds can be found in different products. A review by Drake and Hazelwood in 2005 listed numerous uses of silver compounds, including, but not limited to, photographic plates, batteries, bactericides, catalysts, medicinals, lubrications, cloud seeding, window coatings, mirrors, flower preservatives, electroplating, sanitation products, and acupuncture needles. In the same review, products containing silver and silver alloys include jewelry, silverware, electronic components, heat sinks, solders, brazing alloys, superconductors, bactericides, dental fillings, bearings, coins, and medals.</p><p>
|
|
<b>Occupational Exposure</b>
|
|
</p><p>Occupational exposure can be associated with repeated exposure to small silver particles. Professions at risk include silversmiths, miners, welders, jewelers, and those in the photographic industry. Occupational exposure limits can vary by organization. The European Commission recommends an 8-hour time-weighted average of 0.1 mg/m³ for total silver dust. Other European countries have set separate recommended exposure levels of 0.1 mg/m³ for metallic silver and 0.01 mg/m³ for soluble silver. The Occupational Safety and Health Administration and the Mine Safety and Health Administration recognize a Permissible Exposure Limit of 0.01 mg/m³. Similarly, the National Institute for Occupational Safety and Health has a recommended exposure limit of the same value for metallic and soluble silver.</p><p>
|
|
<b>Medical Uses</b>
|
|
</p><p>Medical uses of silver include silver nitrate for cauterization and silver sulfadiazine for the topical treatment of burns and wounds. Minute levels of silver cations have microbicidal properties that are effective in wound and burn treatment. Medical device catheters are also layered with silver to prevent microbial growth.<a class="bibr" href="#article-165065.r5" rid="article-165065.r5">[5]</a> The antimicrobial property of silver is hypothesized to be related to the ability of silver ions to combine with and permanently damage bacterial membranes.<a class="bibr" href="#article-165065.r6" rid="article-165065.r6">[6]</a></p><p>
|
|
<b>Consumer Uses</b>
|
|
</p><p>Due to the proposed oligodynamic effect, consumer use includes colloidal silver as an over-the-counter dietary and health supplement in alternative and homeopathic medicine. Silver has also been utilized in grooming and hygiene products, such as bandages, shower gels, and deodorants.<a class="bibr" href="#article-165065.r7" rid="article-165065.r7">[7]</a> The 1994 Dietary Supplement Health and Education Act allows silver to be sold as a supplement as long as no claim of treatment or prevention of any disease is apparent.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a></p><p>The most common adverse effects linked to silver are argyria, irreversible bluish-gray skin pigmentation, and argyrosis, irreversible pigmentation of the eyes. These effects are most noticeable in areas that are exposed to sunlight.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> Argyria is typically associated with prolonged exposure to silver, including applying silver-containing materials to the skin or body, inhalation in occupational settings, ingestion, and use of colloidal silver and silver-containing medicinals, smoking deterrents, dental materials, and silver solder.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a> The toxicity of silver nanoparticles in different organs is hypothesized to be due to the same proposed mechanisms of the antimicrobial effects of silver nanoparticles—vigorous oxidation due to ample discharge of silver ions.<a class="bibr" href="#article-165065.r10" rid="article-165065.r10">[10]</a></p></div><div id="article-165065.s4"><h2 id="_article-165065_s4_">Epidemiology</h2><p>Silver has been used dating back to ancient civilizations. The discovery and development of antibiotics in the early to mid-20th century led to a decline in the use of silver as an antimicrobial agent. Although rare, cases of argyria still occur. These instances are generally associated with consuming colloidal silver as a form of alternative and homeopathic medicine as readily available in pharmacies, grocery stores, and online.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> Recent re-emergence in cases of argyria has occurred due to these alternative health treatment trends.<a class="bibr" href="#article-165065.r11" rid="article-165065.r11">[11]</a> The 1994 Dietary Supplement Health and Education Act allowed silver to be sold as a supplement as long as no claim of treatment or prevention of any disease was apparent.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> In 1999, the United States Food and Drug Administration issued a final rule that all over-the-counter drug products containing colloidal silver ingredients or silver salts for internal or external use are not generally recognized as safe and effective and are misbranded.<a class="bibr" href="#article-165065.r12" rid="article-165065.r12">[12]</a></p><p>Recently, there has been an increase in the use of ionic and nanoparticulate silver in medical and commercial products.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a> Colloidal silver comprises silver particles and ions less than 100 nm (nanoparticles) and less than 1000 nm (microparticles) in size dispersed in an aqueous suspension. Most products containing colloidal on the market are claimed to contain 10 to 30 mg/L of silver. The World Health Organization (WHO) has given a Reference Dose (RfD) of 6.5 mcg/kg body weight/day for all exposure routes for the general population, based on argyria development, which is not the most sensitive toxicity endpoint.<a class="bibr" href="#article-165065.r10" rid="article-165065.r10">[10]</a></p><p>The mass production and subsequent commercialization of colloidal silver have adverse effects, including a lack of production standardization and unanticipated adverse effects. Regulatory bodies such as the Food and Drug Administration and the European Commission have taken a stance against health claims without scientific basis. Although they do not prohibit selling colloidal silver, unsubstantiated health claims are prohibited.<a class="bibr" href="#article-165065.r7" rid="article-165065.r7">[7]</a></p></div><div id="article-165065.s5"><h2 id="_article-165065_s5_">Pathophysiology</h2><p>The complications of silver toxicity include dermatologic, cardiovascular, hematologic, hepatic, gastrointestinal, neurologic, and renal findings.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> The most common manifestation of excessive silver exposure is argyria, a condition characterized by bluish-gray skin discoloration. Argyria can be generalized, localized, or ocular. However, more severe manifestations of silver toxicity have been demonstrated. In a large enough dose, silver is acutely toxic. An intravenous dose of about 50 mg of silver is considered fatal, leading to bone marrow, renal, and hepatic necrosis, hemorrhage, and pulmonary edema.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> Although silver is not considered carcinogenic, genotoxic effects have been reported. There are no known effective chelators for treating silver toxicity.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a></p><p>Although the exact antimicrobial mechanism of silver is unknown, the proposed mechanisms include induction of oxidative stress, interaction with cellular membranes, and inhibition of cellular processes.<a class="bibr" href="#article-165065.r5" rid="article-165065.r5">[5]</a><a class="bibr" href="#article-165065.r6" rid="article-165065.r6">[6]</a> Silver has various oxidation states, including Ag<sup>+</sup>, Ag<sup>2+</sup>, and Ag<sup>3+</sup>, with Ag<sup>+</sup> being the most biologically active oxidation state. Silver induces reactive oxygen species by inactivating the respiratory chain dehydrogenase. This inactivation blocks the respiratory chain electron transfer, leading to decreased ATP production by inhibiting cellular respiration and growth. Oxidative stress plays an important role in the cytotoxicity of silver, leading to inflammation and apoptosis.<a class="bibr" href="#article-165065.r13" rid="article-165065.r13">[13]</a></p><p>Silver's proposed activity is related to silver ion interactions with thiol groups in enzymes by binding to electron donor groups of proteins, inhibiting enzymatic activities and causing protein denaturation and precipitation.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> This process can occur by destroying the cell wall and membrane, increasing the cytoplasmic membrane's permeability and causing the destruction of the bacterial envelope. Silver nanoparticles transport silver ions to bacterial cells, reducing pH and increasing silver ion release.<a class="bibr" href="#article-165065.r14" rid="article-165065.r14">[14]</a> In addition, silver binding to DNA affects the replication of DNA and cell proliferation.<a class="bibr" href="#article-165065.r15" rid="article-165065.r15">[15]</a> Silver disrupts sodium-potassium-ATPase by interacting with sulfhydryl groups, causing rapid and potent enzymatic inhibition.<a class="bibr" href="#article-165065.r16" rid="article-165065.r16">[16]</a></p></div><div id="article-165065.s6"><h2 id="_article-165065_s6_">Histopathology</h2><p>Silver particles have a dark brown to black granular appearance. In the dermis, they are scattered extracellularly and are concentrated in the basement membrane of nerves, capillary walls, perifollicular sheath, and elastic fibers. In old lesions, electron-dense granules are observed in lysosomes of macrophages or extracellularly using scanning electron microscopy.<a class="bibr" href="#article-165065.r17" rid="article-165065.r17">[17]</a></p></div><div id="article-165065.s7"><h2 id="_article-165065_s7_">Toxicokinetics</h2><p>
|
|
<b>Absorption</b>
|
|
</p><p>The absorption of silver can occur through multiple modalities, including inhalation, oral ingestion, or skin contact. The rate of silver absorption depends on both the route of exposure and the form of silver. Specifically, particle size plays a role as smaller nanoparticles are more easily absorbed into the bloodstream, possibly leading to systemic exposure. An in vivo study using radiolabeled silver showed accumulation after 2 to 8 hours of exposure, with clearance within 28 days. Oral absorption through the gastrointestinal tract can vary based on other dietary components potentially affecting silver's bioavailability.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> The estimated absorption of ingested silver is up to 10%.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a> Dermal exposure can be affected by prolonged exposure and exposure to areas of skin breakdown, which is important for specific medical devices and dressings.</p><p>
|
|
<b>Distribution</b>
|
|
</p><p>After silver is absorbed, it is distributed through the bloodstream, binding to plasma proteins and transporting them to various organs and tissues. Detectable levels of silver were reported in the blood within 6 hours and in the urine within 24 hours after the application of silver sulfadiazine. Silver binds with sulfur-containing molecules, accumulating in the skin, hair, and nails. Silver can cross the blood-brain and placental barriers.</p><p>
|
|
<b>Metabolism</b>
|
|
</p><p>Silver metabolism is limited in the body. However, interaction with other molecules can lead to biotransformation, which affects its bioavailability.<a class="bibr" href="#article-165065.r6" rid="article-165065.r6">[6]</a><a class="bibr" href="#article-165065.r18" rid="article-165065.r18">[18]</a> The biological half-life of silver in the liver is 50 days.</p><p>
|
|
<b>Excretion</b>
|
|
</p><p>Silver is primarily excreted through the feces by biliary secretion and is also excreted through the urine in smaller quantities. The mean urinary excretion of silver was approximately 1100 µg/L compared to levels of less than 1 µg/L in control levels. The elimination of silver is estimated at 46.4 days from serum, with a median elimination rate of 1.5% per day.<a class="bibr" href="#article-165065.r19" rid="article-165065.r19">[19]</a> The efficiency of urinary excretion is impacted by renal clearance.<a class="bibr" href="#article-165065.r20" rid="article-165065.r20">[20]</a> Additional routes of excretion include sweat, saliva, and breast milk.<a class="bibr" href="#article-165065.r6" rid="article-165065.r6">[6]</a></p></div><div id="article-165065.s8"><h2 id="_article-165065_s8_">History and Physical</h2><p>A medical diagnosis of silver toxicity requires a high level of clinical suspicion, often accompanied by a history of silver exposure through occupational, medicinal, or consumer exposures. An emphasis on obtaining an extended history of over-the-counter, natural, alternative, or homeopathic supplements may heighten clinical suspicion. The onset of pigmentation can vary widely, ranging from days to years. Given that the deposition is permanent, the diagnosis of argyria can be made regardless of the time that has passed since the initial exposure.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a></p><p>Physical examination findings include localized and generalized blue to slate-gray skin pigmentation secondary to silver deposition.<a class="bibr" href="#article-165065.r2" rid="article-165065.r2">[2]</a> Generalized argyria progresses in stages, beginning with staining of the gingiva, followed by hyperpigmentation in sun-exposed areas, and then affecting the nail beds, sclerae, and mucosa. In addition, viscera are noted to appear blue on autopsy. Sun-exposed areas are typically darker secondary to sunlight, leading to a decrease in elemental silver and causing a darker pigmented discoloration.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a><a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> The photoactivation of sun-exposed areas reduces silver, which accelerates the stimulation of melanocytes by silver to increase melanin production.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> The increased production can be observed in the skin, nails, eyes, and mucosal surfaces.</p></div><div id="article-165065.s9"><h2 id="_article-165065_s9_">Evaluation</h2><p>The normal value of silver in blood is less than 1 mcg/L. Silver can be measured in the blood, feces, and urine.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a> The lowest level for silver buildup to result in generalized argyria varies considerably, and thus, argyria is typically diagnosed through history and physical exams. No minimum serum silver levels are consistent with early argyria.<a class="bibr" href="#article-165065.r18" rid="article-165065.r18">[18]</a> Estimated cumulative doses leading to generalized argyria in humans have been reported as low as 70 mg/kg body weight.<a class="bibr" href="#article-165065.r13" rid="article-165065.r13">[13]</a> A skin biopsy and histopathological analysis are useful, with the gold standard being energy-dispersive x-ray spectroscopy. This technique allows for unequivocal diagnosis by identification of the chemical elements found in the granules through analysis of their emitted energy spectrum.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a><a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a></p></div><div id="article-165065.s10"><h2 id="_article-165065_s10_">Treatment / Management</h2><p>There is no specific antidote available to silver toxicity, and treatment of toxicity is supportive.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> The treatment for argyria is limited with overall poor response and is historically considered permanent. A major focus of management is to limit exacerbating factors, such as avoiding further exposure to silver, limiting sun exposure, and utilizing sun protection.<a class="bibr" href="#article-165065.r21" rid="article-165065.r21">[21]</a> Potential treatments with hydroquinone, dermabrasions, and D-penicillamine have been attempted without notable results.</p><p>In recent reports, Q-switched frequency neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy, which is used for removing certain tattoos, has also been attempted with documentation of successful improvement of discoloration after treatments with low-fluence Q-switched 1064-nm Nd:YAG laser and 755-nm alexandrite laser.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a><a class="bibr" href="#article-165065.r22" rid="article-165065.r22">[22]</a><a class="bibr" href="#article-165065.r23" rid="article-165065.r23">[23]</a> Persistent skin color restoration up to 1 year after treatment has been reported; however, argyria relapse 11 months after has also been reported. Adverse effects of the laser procedure include intense pain, which may require various types of anesthesia, including general anesthesia.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a></p></div><div id="article-165065.s11"><h2 id="_article-165065_s11_">Differential Diagnosis</h2><p>The differential diagnosis of silver toxicity includes:</p><ul><li class="half_rhythm"><div>Addison disease</div></li><li class="half_rhythm"><div>Amiodarone use</div></li><li class="half_rhythm"><div>Chrysiasis</div></li><li class="half_rhythm"><div>Cyanosis</div></li><li class="half_rhythm"><div>Dapsone use</div></li><li class="half_rhythm"><div>Hemochromatosis</div></li><li class="half_rhythm"><div>Melanoma</div></li><li class="half_rhythm"><div>Methemoglobinemia</div></li><li class="half_rhythm"><div>Minocycline use</div></li><li class="half_rhythm"><div>Ochronosis</div></li><li class="half_rhythm"><div>Phenothiazine use</div></li><li class="half_rhythm"><div>Polycythemia</div></li><li class="half_rhythm"><div>Porphyria</div></li><li class="half_rhythm"><div>Wilson disease</div></li></ul></div><div id="article-165065.s12"><h2 id="_article-165065_s12_">Toxicity and Adverse Effect Management</h2><p>When silver is ingested, approximately 10% is absorbed in the gastrointestinal tract and circulated by the vasculature. Silver is primarily excreted in bile and eliminated through feces, and to a lesser extent, eliminated in urine.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a><a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> In today’s society, presentations of generalized argyria are most commonly observed in patients who utilize colloidal silver as a form of complementary health supplementation.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> Inhaling silver particulates or aerosols leads to the accumulation of silver in the lungs and bloodstream.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a><a class="bibr" href="#article-165065.r20" rid="article-165065.r20">[20]</a> The Recommended Exposure Level and Permissible Exposure Level for both are 0.1 mg/m<sup>3</sup>, according to the National Institute of Occupational Safety and Health established by the Occupational Health and Safety Administration. Contact exposure to silver can occur through wound dressings, jewelry, and nasal or ophthalmologic drops, typically leading to localized argyria. However, contact exposure can still lead to generalized argyria.<a class="bibr" href="#article-165065.r2" rid="article-165065.r2">[2]</a><a class="bibr" href="#article-165065.r13" rid="article-165065.r13">[13]</a></p></div><div id="article-165065.s13"><h2 id="_article-165065_s13_">Prognosis</h2><p>Argyria is mainly irreversible and does not improve after discontinuation of exposure. Argyria is not a life-threatening condition; however, the metal demonstrates systemic absorption and distribution of silver, leading to an unfavorable cosmetic appearance with permanent skin discoloration in the affected areas.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> The highest concentrations of silver are found in the skin, liver, kidneys, cornea, and gingiva, as indicated by autopsy analysis of individuals treated with silver for burns.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a></p></div><div id="article-165065.s14"><h2 id="_article-165065_s14_">Complications</h2><p>
|
|
<b>Systemic Complications</b>
|
|
</p><p>Systemic complications of silver toxicity have been described in the literature in the form of animal studies and case reports. Silver has been demonstrated to accumulate throughout the body in animal research. Systemic complications include cardiovascular, dermatologic, hematologic, hepatic, gastrointestinal, neurologic, and renal findings.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a><a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> </p><p>
|
|
<b>Dermatologic: </b>Argyria, the development of bluish-gray skin discoloration, is the most well-known complication of silver exposure. There are 3 main subtypes of argyria—generalized argyria, localized argyria, and argyrosis. Generalized argyria occurs after systemic exposure, resulting in gray-blue or metallic diffuse skin pigmentation, most prominent in sun-exposed areas. Early signs include pigmentation of the gingiva and oral mucosa followed by bluish discoloration of the fingernails called azure lunula. Localized argyria is caused by local silver deposition due to transdermal absorption by sweat gland pores or skin incisions. This condition is observed after prolonged contact with silver-containing products, creams, solutions, or cautery. The most common form of localized argyria is amalgam tattoo, a flat, dark-blue mucosal lesion. Argyrosis is an ocular silver deposition that can occur as a manifestation of generalized or localized argyria. Argyrosis can be observed in the cornea, conjunctivae, and lacrimal caruncle and may have dark lesions with greenish and brownish tones.<a class="bibr" href="#article-165065.r4" rid="article-165065.r4">[4]</a> </p><p>
|
|
<b>Neurologic: </b>Neurologic complications include accumulation of silver in neuron and glial cells of the brain and spinal cord, potential central nervous system dysfunction in mice exposed to silver salts, and a decrease in emergent hippocampal pyramidal cells in fetal rats. In addition, a report described a 55-year-old woman who experienced increasing vertigo, weakness, hyposmia, gait disturbance, and cutaneous hypoesthesia after self-treating oral mycosis with silver products for 9 years. This prolonged use of silver products led to silver sulfide depositions found in basal membranes, macrophages, elastic and collagenous fibers, perineurium of peripheral nerves, and necrotic cells of the oral submucosa. A case reported by Ohbo et al suggests a causal relationship of convulsive seizures in a patient with schizophrenia with argyria secondary to addiction to antismoking pills containing silver with serum levels of 12 mcg/L.<a class="bibr" href="#article-165065.r24" rid="article-165065.r24">[24]</a></p><p>
|
|
<b>Renal: </b>Reported renal findings include proteinuria and damaged glomeruli in other cases. A patient developed chronic abdominal pain after using topical silver for 2 and a half years to help with recurrent gingival bleeding, which led to generalized argyria. The patient underwent an abdominal operation, during which diffuse argyria of multiple internal organs was observed.</p><p>
|
|
<b>Hematologic: </b>In the bone marrow, silver sulfadiazine use has been shown to suppress leukocyte progenitor cells in mice studies, along with leukopenia and lowered granulocyte counts in patients with burn wounds.<a class="bibr" href="#article-165065.r18" rid="article-165065.r18">[18]</a> </p><p>
|
|
<b>Hepatic: </b>Rats deficient in vitamin E or selenium developed hepatic necrosis due to selenium deficiency caused by silver, which obstructed the production of the seleno-enzyme glutathione peroxidase.</p><p>
|
|
<b>Cardiovascular: </b>In a case report by Steininger et al, a 52-year-old patient who died from cardiac failure was found to have silver deposits in the walls of most blood vessels on autopsy. This patient was treated for a duodenal ulcer for over 18 years with 35 g of silver. In a study by Olcott, rats given silver nitrate drinking water developed left ventricular enlargement. [ATSDR. <a href="https://www.atsdr.cdc.gov/ToxProfiles/tp146.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Toxicological Profile for Silver</a>]</p><p>
|
|
<b>Respiratory: </b>Inhalation of silver can lead to pneumonitis, with reports of both upper and lower respiratory irritation. Tracheal epithelium structural damage was observed in rabbits who experienced inhalation exposure to colloidal silver. A case report by Forycki et al described a man hospitalized approximately 36 hours after exposure to silver vapors from melting silver ingots, presenting with severe circulatory and respiratory symptoms requiring controlled respiration with positive end-expiratory pressure.<a class="bibr" href="#article-165065.r3" rid="article-165065.r3">[3]</a><a class="bibr" href="#article-165065.r25" rid="article-165065.r25">[25]</a></p><p>
|
|
<b>Fatal Dose</b>
|
|
</p><p>The reported fatal dose of intravenous colloidal silver is 50 mg acutely, leading to bone marrow, renal, and hepatic necrosis, hemorrhage, and pulmonary edema.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a> Additional sources report an average fatal dose of 10 g, although survival after 30 g is also reported.<a class="bibr" href="#article-165065.r8" rid="article-165065.r8">[8]</a> The World Health Organization reports a lifetime intake of approximately 10 g of silver can be considered the no-observed<b>-</b>adverse-effect level in humans.<a class="bibr" href="#article-165065.r18" rid="article-165065.r18">[18]</a> In a review by Fung et al, the systemic effects of silver are discussed. Human mortality has been reported in the literature, including a case involving intrauterine silver nitrate administration of 7 g (approximately 64 mg silver/kg by weight) following an abortion procedure.<a class="bibr" href="#article-165065.r13" rid="article-165065.r13">[13]</a></p></div><div id="article-165065.s15"><h2 id="_article-165065_s15_">Deterrence and Patient Education</h2><p>Patient education regarding the risks and adverse effects of silver toxicity is crucial, including the potentially irreversible dermatologic effects of argyria. Improving awareness that government regulations of the commercial sales of colloidal silver occur with nonscientific-based claims of health benefits should also be noted.<a class="bibr" href="#article-165065.r7" rid="article-165065.r7">[7]</a><b> </b>Psychological counseling and education regarding available treatment modalities are beneficial.<a class="bibr" href="#article-165065.r9" rid="article-165065.r9">[9]</a></p></div><div id="article-165065.s16"><h2 id="_article-165065_s16_">Enhancing Healthcare Team Outcomes </h2><p>Cases of silver toxicity are rare; however, they still occur in modern society. Clinicians must maintain a high clinical index of suspicion regarding obtaining pertinent history of silver exposure, including occupational history, medications, supplements, and alternative therapies to ensure an accurate diagnosis. Careful consideration is warranted when excluding other pigmentation-based diagnoses.</p><p>An interprofessional team is crucial for the diagnosis and management of silver toxicity. This team may include clinicians, toxicologists, dermatologists, and pathologists. Nurses play a vital role in this interprofessional team by coordinating the collection of blood and tissue specimens, assisting with patient examinations and history-taking, and counseling patients and their families regarding the condition and its management. This collaborative approach ensures comprehensive care and improves patient outcomes.</p></div><div id="article-165065.s17"><h2 id="_article-165065_s17_">Review Questions</h2><ul><li class="half_rhythm"><div>
|
|
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=165065&utm_source=pubmed&utm_campaign=reviews&utm_content=165065" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="https://mdsearchlight.com/poisons/silver-toxicity/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=165065" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Click here for a simplified version.</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="https://www.statpearls.com/articlelibrary/commentarticle/165065/?utm_source=pubmed&utm_campaign=comments&utm_content=165065" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Comment on this article.</a>
|
|
</div></li></ul></div><div id="article-165065.s18"><h2 id="_article-165065_s18_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-165065.r1">Betts HD, Whitehead C, Harris HH. Silver in biology and medicine: opportunities for metallomics researchers. <span><span class="ref-journal">Metallomics. </span>2021 Jan 16;<span class="ref-vol">13</span>(1)</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33570135" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33570135</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-165065.r2">Griffith RD, Simmons BJ, Bray FN, Falto-Aizpurua LA, Yazdani Abyaneh MA, Nouri K. 1064 nm Q-switched Nd:YAG laser for the treatment of Argyria: a systematic review. <span><span class="ref-journal">J Eur Acad Dermatol Venereol. </span>2015 Nov;<span class="ref-vol">29</span>(11):2100-3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25845405" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25845405</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="article-165065.r3">Drake PL, Hazelwood KJ. Exposure-related health effects of silver and silver compounds: a review. <span><span class="ref-journal">Ann Occup Hyg. </span>2005 Oct;<span class="ref-vol">49</span>(7):575-85.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15964881" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15964881</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="article-165065.r4">Mota L, Dinis-Oliveira RJ. Clinical and Forensic Aspects of the Different Subtypes of Argyria. <span><span class="ref-journal">J Clin Med. </span>2021 May 13;<span class="ref-vol">10</span>(10)</span> [<a href="/pmc/articles/PMC8152497/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8152497</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34068024" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34068024</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="article-165065.r5">Silver S. Bacterial silver resistance: molecular biology and uses and misuses of silver compounds. <span><span class="ref-journal">FEMS Microbiol Rev. </span>2003 Jun;<span class="ref-vol">27</span>(2-3):341-53.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12829274" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12829274</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="article-165065.r6">Lansdown AB. Silver in health care: antimicrobial effects and safety in use. <span><span class="ref-journal">Curr Probl Dermatol. </span>2006;<span class="ref-vol">33</span>:17-34.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16766878" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16766878</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="article-165065.r7">Sim W, Barnard RT, Blaskovich MAT, Ziora ZM. Antimicrobial Silver in Medicinal and Consumer Applications: A Patent Review of the Past Decade (2007⁻2017). <span><span class="ref-journal">Antibiotics (Basel). </span>2018 Oct 26;<span class="ref-vol">7</span>(4)</span> [<a href="/pmc/articles/PMC6315945/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6315945</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30373130" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30373130</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="article-165065.r8">Fung MC, Bowen DL. Silver products for medical indications: risk-benefit assessment. <span><span class="ref-journal">J Toxicol Clin Toxicol. </span>1996;<span class="ref-vol">34</span>(1):119-26.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8632503" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8632503</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="article-165065.r9">Jerger SE, Parekh U. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Argyria. [<a href="https://pubmed.ncbi.nlm.nih.gov/33085270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33085270</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="article-165065.r10">Leino V, Airaksinen R, Viluksela M, Vähäkangas K. Toxicity of colloidal silver products and their marketing claims in Finland. <span><span class="ref-journal">Toxicol Rep. </span>2021;<span class="ref-vol">8</span>:106-113.</span> [<a href="/pmc/articles/PMC7786010/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7786010</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33437653" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33437653</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="article-165065.r11">Gill P, Richards K, Cho WC, Nagarajan P, Aung PP, Ivan D, Curry JL, Prieto VG, Torres-Cabala CA. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. <span><span class="ref-journal">Ann Diagn Pathol. </span>2021 Oct;<span class="ref-vol">54</span>:151776.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34214703" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34214703</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="article-165065.r12">Over-the-counter drug products containing colloidal silver ingredients or silver salts. Department of Health and Human Services (HHS), Public Health Service (PHS), Food and Drug Administration (FDA). Final rule. <span><span class="ref-journal">Fed Regist. </span>1999 Aug 17;<span class="ref-vol">64</span>(158):44653-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10558603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10558603</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="article-165065.r13">Hadrup N, Sharma AK, Loeschner K. Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review. <span><span class="ref-journal">Regul Toxicol Pharmacol. </span>2018 Oct;<span class="ref-vol">98</span>:257-267.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30125612" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30125612</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="article-165065.r14">Mikhailova EO. Silver Nanoparticles: Mechanism of Action and Probable Bio-Application. <span><span class="ref-journal">J Funct Biomater. </span>2020 Nov 26;<span class="ref-vol">11</span>(4)</span> [<a href="/pmc/articles/PMC7711612/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7711612</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33255874" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33255874</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-165065.r15">Li H, Xu H. Mechanisms of bacterial resistance to environmental silver and antimicrobial strategies for silver: A review. <span><span class="ref-journal">Environ Res. </span>2024 May 01;<span class="ref-vol">248</span>:118313.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/38280527" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 38280527</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-165065.r16">Hussain S, Meneghini E, Moosmayer M, Lacotte D, Anner BM. Potent and reversible interaction of silver with pure Na,K-ATPase and Na,K-ATPase-liposomes. <span><span class="ref-journal">Biochim Biophys Acta. </span>1994 Mar 23;<span class="ref-vol">1190</span>(2):402-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8142442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8142442</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-165065.r17">Molina-Hernandez AI, Diaz-Gonzalez JM, Saeb-Lima M, Dominguez-Cherit J. Argyria after Silver Nitrate Intake: Case Report and Brief Review of Literature. <span><span class="ref-journal">Indian J Dermatol. </span>2015 Sep-Oct;<span class="ref-vol">60</span>(5):520.</span> [<a href="/pmc/articles/PMC4601443/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4601443</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26538722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26538722</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-165065.r18">Lansdown AB. A pharmacological and toxicological profile of silver as an antimicrobial agent in medical devices. <span><span class="ref-journal">Adv Pharmacol Sci. </span>2010;<span class="ref-vol">2010</span>:910686.</span> [<a href="/pmc/articles/PMC3003978/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3003978</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21188244" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21188244</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-165065.r19">Walker M, Parsons D. The biological fate of silver ions following the use of silver-containing wound care products - a review. <span><span class="ref-journal">Int Wound J. </span>2014 Oct;<span class="ref-vol">11</span>(5):496-504.</span> [<a href="/pmc/articles/PMC7950569/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7950569</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23173975" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23173975</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-165065.r20">DiVincenzo GD, Giordano CJ, Schriever LS. Biologic monitoring of workers exposed to silver. <span><span class="ref-journal">Int Arch Occup Environ Health. </span>1985;<span class="ref-vol">56</span>(3):207-15.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4066049" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4066049</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-165065.r21">Chow N, Fain K, Truitt J, Stetson C. Systemic argyria with severe anemia (hemoglobin 2.4 g/L). <span><span class="ref-journal">Proc (Bayl Univ Med Cent). </span>2022;<span class="ref-vol">35</span>(3):382-384.</span> [<a href="/pmc/articles/PMC9045415/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9045415</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35518817" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35518817</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-165065.r22">Han TY, Chang HS, Lee HK, Son SJ. Successful treatment of argyria using a low-fluence Q-switched 1064-nm Nd:YAG laser. <span><span class="ref-journal">Int J Dermatol. </span>2011 Jun;<span class="ref-vol">50</span>(6):751-3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21595676" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21595676</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-165065.r23">Almurayshid A, Park S, Oh SH. Effective laser treatment options for argyria: Review of literatures. <span><span class="ref-journal">J Cosmet Dermatol. </span>2020 Aug;<span class="ref-vol">19</span>(8):1877-1882.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32538530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32538530</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-165065.r24">Ohbo Y, Fukuzako H, Takeuchi K, Takigawa M. Argyria and convulsive seizures caused by ingestion of silver in a patient with schizophrenia. <span><span class="ref-journal">Psychiatry Clin Neurosci. </span>1996 Apr;<span class="ref-vol">50</span>(2):89-90.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8783381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8783381</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-165065.r25">Forycki Z, Zegarski W, Bardzik J, Swica P. Acute silver poisoning through inhalation. <span><span class="ref-journal">Bull Inst Marit Trop Med Gdynia. </span>1983;<span class="ref-vol">34</span>(3-4):199-203.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6681363" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6681363</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
|
|
<b>Disclosure: </b>Matthew Steck declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
|
|
<b>Disclosure: </b>Brian Murray declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK604211_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Matthew B. Steck</span><sup>1</sup>; <span itemprop="author">Brian P. Murray</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Michigan State University College of Osteopathic Medicine, McLaren Macomb Hospital</div><div class="affiliation"><sup>2</sup> Wright State University Boonshoft School of Medicine</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">October 28, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
|
|
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
|
|
(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
|
|
http://creativecommons.org/licenses/by-nc-nd/4.0/
|
|
</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
|
|
</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Steck MB, Murray BP. Silver Toxicity. [Updated 2024 Oct 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|