See [[Foreign body ingestion]] see also: [Austin Button Battery ingestion](x-devonthink-item://03461E4E-6AB2-4CBA-9FA4-394C6245E70F) #paeds > [!warning] Honey First Aid > 10 mL of honey every 10 minutes (up to 6 doses in children > 12 months old) may be administered orally as first aid but MUST NOT delay transport to hospital, X-ray, and endoscopy if indicated. ## Risk Assessment - lithium batteries >20mm diameter are high risk for lodging and causing serious injury. smaller cells can also cause injury - injury can occur within 2 hours - in young children, ==early symptoms are often non-specific== eg pain, nausea, vomiting, or loss of appetite and a history of ingestion may not be readily available . consider button battery if [haematemesis](https://www.stuff.co.nz/nz-news/360509040/toddler-swallows-button-battery-healthy-girl-medical-drama) in young child ## Management - [[#X ray findings|X-Ray]] entire alimentary tract in any suspected button battery ingestion - treatment will depend on location | Time-critical endoscopy (within 2 hours) | Emergency endoscopy | Expectant management | | ---------------------------------------- | --------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Button battery in oesophagus* | Button batteries in stomach in symptomatic children | - Batteries in stomach or beyond without signs of GI injury should be discussed with relevant specialist to determine a plan / timeframe for intervention<br>- *stomach:* often discharge and return for repeat AXR in 48 hours post ingestion and represent PRN if symptoms in interim<br>- *distal to stomach:* often expected passage in 1-2 weeks, re-present earlier if symptoms, and repeat AXR after 10-14 days | \*Administer honey to children >1 year with an oesophageal button battery within 12 hours of ingestion whilst awaiting theatre. Dose 10 mL every 10 minutes up to 6 doses > note that further imaging beyond plain AXR is usually only required after endoscopic removal to evaluate extent of injury ## X ray findings - on AP view disc battery in oesophagus will tend to appear as an O as the long axis will line up with the longest axis of the oesophagus - disc battery in trachea will appear as an I as the long axis will tend to line up with the longest axis of the trachea which is in the sagittal plane - button batteries typically appear with a "double-ring" or *halo sign* . this feature may help differentiate a button from a coin - step off or central bulge appearance on lateral view for the button battery **Note** that button battery may appear flat ![[Pasted image 20250113075343.png]] Note the *halo* supporting button battery ![[Pasted image 20250113075540.png]] ![[Pasted image 20250113080039.png]] ### Coin vs Battery on XR ![[Pasted image 20250113075458.png]] ## Button battery pathology may cause perforation or an oesophagotracheal fistula and must be removed endoscopically as soon as possible. - leakage of potassium hydroxide and mercuric oxide - hydrolysis and creation of hydroxide ions in adjacent tissues lead to mucosal burn at batter's negative pole - liquefaction necrosis - alkali produced from external flow of current - direct pressure leading to necrosis