Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children
Study type: Narrative review of new guideline from the National Capital Poison Centre (USA) on management of button battery ingestion
Guideline: Patients <12 years old, or with batteries >12mm or unknown size, or co-ingestion with a magnet, should proceed immediately to endoscopic removal. Consideration of transfer to a paediatric centre depends on timeliness and local facilities available, bearing in mind the urgency of removal. Neutralization therapy is new to this guideline: Honey (a weak acid) has been shown in piglet models to reduce the necrosis caused by the alkaline reaction, and should be administered in 10ml doses every 10 minutes up to 6 doses in children >1year, while awaiting but not delaying theatre. Sucralfate can also be used. In addition, acetic acid irrigation should occur intraoperatively. Asymptomatic patients >12 years old with sensible parents can be managed conservatively.
Take home messages
A reminder that button battery ingestion is serious and potentially fatal, due to an electrolytic reaction which generates a highly alkaline environment at the negative pole (narrow side) of the battery leading to liquefactive tissue necrosis, which can progress to tracheal or aortic injuries. Injury begins within 15 minutes. Highest risk of mortality are patients <5 years old, who have ingested batteries >20mm in diameter, with negative pole facing posteriorly in the oesophagus. Oesophageal perforation becomes a risk after 12 hours.
Reviewed by: Dr Claire Furyk