What are the treatment protocols for honey and button battery ingestion?

Button Battery Ingestion Management Protocol

In cases of button battery ingestion, emergent flexible endoscopy (preferably within 2 hours, at latest within 6 hours) is essential due to the high risk of pressure necrosis, electrical burns, and chemical injury. 1

Immediate Management

For Suspected or Confirmed Button Battery Ingestion:

• Immediately locate the position of the battery through imaging (CT scan is the key examination in patients with suspected perforation or other battery-related complications) 1
• For esophageal impaction:
  • Activate emergency medical services immediately 1
  • In children with ingestion <12 hours old, administration of honey or sucralfate can be considered while awaiting endoscopic removal, but should NOT delay transport to medical care 2, 3
  • Emergent endoscopic removal (preferably within 2 hours, at latest within 6 hours) is mandatory 1

Post-Identification Protocol:

• For esophageal impaction:

  • Immediate endoscopic removal is required regardless of symptoms 1
  • Do not administer anything by mouth except honey (in children >1 year) or sucralfate if ingestion is <12 hours old and removal will be delayed 3, 4
  • Do not induce vomiting or administer activated charcoal 1

• For batteries that have passed the esophagus:

  • In early diagnosis (≤12 hours after ingestion) with asymptomatic patients, monitor with repeat X-ray in 7-14 days if not already evacuated in stool 3
  • In delayed diagnosis (>12 hours), consider endoscopy to screen for esophageal damage and CT scan to rule out vascular injury even in asymptomatic children 3

Special Considerations

• For delayed diagnosis (first confirmation of battery on X-ray >12 hours after ingestion):

  • Perform CT scan to evaluate for vascular injury before removing the battery 3
  • Even if the battery has passed the esophagus, consider endoscopy and CT scan to rule out damage 3

• Post-removal management:

  • Endoscopic acetic acid irrigation post-removal may help halt deeper tissue injury 4
  • Close monitoring for delayed complications is essential, particularly for esophageal perforation, fistula formation, or vascular injury 2

Cautions and Pitfalls

• Do not administer water or milk to dilute the ingestion unless specifically advised by poison control or emergency medical personnel 1
• Do not delay endoscopic removal for batteries lodged in the esophagus - tissue damage can occur rapidly 1
• Mercury toxicity from button batteries is rare and not an immediate concern; focus on mechanical and chemical injury prevention 5
• Honey should only be given to children over 1 year of age due to botulism risk 6
• The effectiveness of honey is time-dependent and should not replace or delay definitive treatment 6

Prevention Strategies

• Secure battery compartments in electronic devices 2
• Raise awareness among parents and childcare providers about the dangers of button batteries 2
• Store batteries out of reach of children 3
• Dispose of used batteries properly 3

The evidence strongly supports immediate intervention for button battery ingestion, particularly when lodged in the esophagus, as delays can lead to severe tissue damage, perforation, fistula formation, and potentially fatal complications 1, 2.