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Topical Antimicrobial / Haemostatic Pregnancy: Caution — avoid large-area use in pregnancy

Silver Nitrate 0.5% Solution

Brand names: Silver Nitrate Solution

Adult dose

Dose: Wet dressings: soak gauze in 0.5% solution, apply to burn; haemostasis (cautery stick 75–95%): apply directly to bleeding point
Route: Topical
Frequency: Change wet dressings every 12–24 hours
Max: Large-area use requires electrolyte monitoring
0.5% solution used for burns coverage — broad-spectrum antimicrobial, covers Pseudomonas. 75–95% silver nitrate sticks for minor haemostasis (e.g. granulation tissue, epistaxis cautery). Turns wound black (silver deposition) — does not indicate necrosis.

Paediatric dose

Route: Topical
Frequency: Every 12–24 hours
Max: Monitor electrolytes closely in children
Used for burns in children — electrolyte leaching more significant in smaller patients. Monitor Na+, K+, Cl- closely.

Dose adjustments

Renal

Monitor electrolytes with large-area burns.

Hepatic

No specific adjustment.

Clinical pearls

  • Black wound discolouration is silver deposition NOT necrosis — an important clinical pitfall that can lead to unnecessary wound debridement
  • Large-area use causes electrolyte leaching through the wound surface — replace Na+, K+, Cl- aggressively
  • Silver nitrate sticks (75–95%) are the standard treatment for over-granulation tissue in chronic wounds — touch briefly to the granulation tissue

Contraindications

  • Hypersensitivity to silver compounds
  • Cautery stick: avoid use in nasopharynx (perforation risk)

Side effects

  • Black staining of wound and surrounding skin (argyria-like)
  • Electrolyte leaching: hyponatraemia, hypochloraemia, hypokalaemia (large burns)
  • Methaemoglobinaemia (rare — large-area high-concentration use)
  • Pain on application

Interactions

  • Other topical agents (compatibility issues — do not combine with silver sulfadiazine)

Monitoring

  • Serum electrolytes daily (large-area use)
  • Wound appearance and healing progress
  • Methaemoglobin if clinically suspected (SpO2 artefact)

Reference: BNFc; BNF 90; BBA Burns Wound Care Guidelines; Herndon DN, Total Burn Care 5th Ed. Verify against your local formulary and the latest BNF before prescribing.