New strategies in mitigating the risks of swallowed button batteries

Button battery ingestion accounts for 8.4% of ingested foreign bodies in children and poses a risk of significant morbidity and mortality. When lodged in the oesophagus, a hydrolysis reaction at the negative pole rapidly causes localised caustic injury leading to severe complications including major haemorrhage. Delayed haemorrhage and perforation can be seen up to 28 days post removal. Current guidelines advocate prompt endoscopic removal within 2 hours. Lerner et al (JPGN 2020, doi: 10.1097/MPG.0000000000002649) discuss the updated guidelines from the American National Capital Poison Center (https://www.poison.org/battery/guideline) on button battery ingestion with the addition of strategies to reduce to tissue damage. These developments have been driven by recent porcine studies which demonstrated reduced tissue damage by neutralising the alkaline tissue environment after battery ingestion, while previous concerns regarding thermal injury from neutralisation measures were unfounded. The new guidelines advocate administering honey and/or sucralfate prior to removal, if less than 12 hours since a suspected or witnessed ingestion. Honey can be administered 10 mL every 10 min up to six times while on route to hospital. In a medical facility, either sucralfate 1 g/10 mL or honey 10 mL can be given every 10 min up to three doses while awaiting radiological confirmation or endoscopic removal. During endoscopic …