How To Manage Button Battery Esophageal Injuries - Mitigation/Neutralization Strategies
1) Pre-Op Mitigation (Note: Do this while waiting to go to the OR - Do not delay endoscopic removal):
- Home (< 12 Hours): Honey - give 10mL (2tsp) po Q 10 minutes up to six doses (for children > 12 months old)
- In Hospital (< 12 hours): Sucralfate - give 10mL po Q 10 minutes up to 3 doses (no age limit)
2) Intra-Op Neutralization:
- If there are no endoscopic signs of esophageal perforation, irrigate the injured area with 50-150mL of sterile 0.25% Acetic Acid
- Obtain the Acetic Acid from the Hospital Pharmacy
- Irrigate the esophagus in increments and suction away the excess Acetic Acid fluid and debris through the endoscope
Source: Afang RR, et al: pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope 2018: Jun 11;
What is the differential diagnosis for stridor that has been present since birth?
1) Laryngomalacia
2) Subglottic stenosis
3) Vocal cord paralysis
4) Vascular ring
5) Recurrent respiratory papillomatosis
Symptoms that should prompt further investigation of hoarseness.
1) Respiratory distress
2) Tachypnea
3) Decreased air entry
4) Tachycardia
5) Cyanosis
6) Chronic cough
7) Failure to thrive
8) Recurrent pneumonia
9) Dysphagia
Notes:
- Any child with slowly progressive hoarseness merits investigation - don’t wait until aphonia or airway problems occur
- The airway/larynx needs to be visualized to evaluate the above symptoms
