Sucralfate Dosing for Button Battery Ingestion in Children
For children with button battery ingestion confirmed within 12 hours, administer 10 mL of sucralfate suspension (1 gram/10 mL) orally every 10 minutes while awaiting endoscopic removal, but do not delay removal beyond 2 hours. 1, 2
Immediate Management Algorithm
Pre-Endoscopy Protective Therapy (If ≤12 hours since ingestion)
- Administer sucralfate 10 mL (1 gram) orally every 10 minutes while preparing for urgent endoscopy 1, 2
- Honey can be used as an alternative (10 mL every 10 minutes for children >1 year old), but sucralfate provides both pH neutralization and a viscous protective barrier 2
- Critical caveat: These protective agents should NEVER delay endoscopic removal—they are temporizing measures only while mobilizing the endoscopy team 1, 2
Timing Considerations
- Esophageal impaction requires immediate removal (preferably <2 hours) regardless of symptom presence 1
- If diagnosis is delayed (>12 hours after ingestion), sucralfate administration is less beneficial and should not be prioritized over immediate imaging and removal 1
- For batteries beyond the esophagus diagnosed early (<12 hours), sucralfate is not indicated—proceed with observation and repeat X-ray in 7-14 days 1
Post-Removal Management
Esophageal Irrigation Protocol
- After battery removal, irrigate the esophageal injury site with 50-150 mL of 0.25% acetic acid to neutralize residual alkaline injury 2
- This irrigation is performed in the operating room immediately following endoscopic removal 2
Delayed Diagnosis Protocol (>12 hours)
- Perform CT scan before removal to evaluate for vascular injury (aorto-esophageal or tracheo-esophageal fistula) 1, 3
- Even if the battery has passed beyond the esophagus, consider endoscopy to screen for esophageal damage and CT to rule out vascular injury, even in asymptomatic children 1
- These complications can be fatal and may present with sudden cardiac arrest or massive hemorrhage 4, 3
Common Pitfalls to Avoid
- Never wait for symptoms to develop—tissue injury from button batteries occurs within 2 hours and can be severe even in asymptomatic children 1, 2
- Do not assume gastric batteries are safe—lithium batteries ≥1.5 cm (3V) can cause major complications even in the stomach and should be removed urgently within 24 hours 5
- Avoid biopsy of irradiated or injured esophageal mucosa as this carries risk of fistula development or necrosis 6
- Do not use sucralfate as a substitute for urgent endoscopy—it is only a temporizing measure to minimize ongoing injury during the brief period before removal 1, 2
Battery-Specific Considerations
- Lithium batteries (≥1.5 cm, 3V) require urgent removal even from the stomach due to higher voltage and greater injury potential 5
- Alkaline batteries (<1.5 cm, 1.5V) have lower complication rates but still require prompt evaluation 5
- The electrical current conducted through saliva and tissue drives highly alkaline caustic injury leading to liquefactive necrosis 2