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A Complication of Silver Sulfadiazine Therapy

Corinne L. Fligner, MD; Rhona Jack, PhD; Gary A. Twiggs, MD; Vidmantas A. Raisys, PhD

JAMA. 1985;253(11):1606-1609.

Abstract
An 8-month-old male infant was treated with topical silver sulfadiazine for a burn and complicating toxic epidermal necrolysis involving 78% of his total body surface area. Transdermal absorption of propylene glycol from the silver sulfadiazine produced hyperosmolality with an increased osmolal gap. A peak propylene glycol concentration of 1,059 mg/dL was documented, and its osmotic effect was that predicted from its concentration. Our data support either zero-order elimination at a rate of 13.5 mg/dL/hr or first-order elimination with a half-life of 16.9 hours. Elevated concentrations of propylene glycol may have contributed to the patient's cardiorespiratory arrest. The osmolal gap may be used as a screen for suspected propylene glycol intoxication in selected clinical settings.

(JAMA 1985;253:1606-1609)

Author Affiliations
From the Children's Orthopedic Hospital and Medical Center (Drs Fligner and Twiggs); and the Departments of Laboratory Medicine (Drs Fligner, Jack, and Raisys), Pediatrics (Dr Twiggs), and Pathology (Dr Fligner), University of Washington, Seattle.

Footnotes
Reprint requests to King County Medical Examiner Office, 325 Ninth Ave, Seattle, WA 98104 (Dr Fligner).

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