IN BRIEF

How Sweet It Is: Honey Attenuates Button Battery-Induced Esophageal Damage

October 22, 2018

Discovery of honey's protective effects results in new National Capital Poison Center guidelines.

After years of searching for a palatable household liquid to help counteract esophageal tissue damage in children who had swallowed a button battery, physician-scientists have struck liquid gold. Honey – tasty enough for kids to happily sip and readily available in most homes – has natural acidity that effectively lowers tissue pH around highly alkaline button batteries lodged in the esophagus, and its viscous composition helps coat the battery to slow additional damage until it can be extracted.

Kris Jatana, MD, a pediatric otolaryngologist and director of Pediatric Otolaryngology Quality Improvement at Nationwide Children’s Hospital who is also part of the leadership of the American Academy of Pediatrics’ National Button Battery Task Force, tested everything from vinegar to apple juice before landing on honey as a potential first-aid solution for button battery ingestions. More than 3,000 cases occur per year, mostly among children younger than age 6, and severe cases are on the rise. Lodged button batteries can cause rapid injury, including permanent bilateral vocal cord paralysis and even death.

Dr. Jatana, co-principal investigator of the study published in The Laryngoscope, first studied the various liquids alone, then initiated tests with tissue samples. Both honey and sucralfate (Carafate®) were able to effectively neutralize the tissue pH and reduce visible injury compared to saline and other household liquids. He then confirmed these preliminary findings with live animal studies, in collaboration with co-principal investigator Ian Jacobs, MD, medical director of the Center for Pediatric Airway Disorders in the Division of Otolaryngology (ENT) at Children’s Hospital of Philadelphia and other researchers.

The team’s work won the distinguished 2018 Broyles-Maloney Award from the American Broncho-Esophagological Association. The investigators previously collaborated on a study published last year that found a weak acetic acid rinse (sterile vinegar) can help neutralize tissue pH and protect the esophagus from continued tissue breakdown after battery removal. This irrigation concept has now been successfully used in children around the world with good clinical outcomes.

“When we’re up against a severe hazard like this, we’re looking to do anything we can to reduce the severity of injury. We know that some pre-removal interventions like this are better than none. Now we will continue to study outcomes as we implement these protective measures in children,” says Dr. Jatana, who has been advocating for improved safety requirements for electronics and battery packaging, as well as consumer awareness, since seeing his first complicated case of battery ingestion more than 10 years ago.

“It’s crucial for parents and caregivers to be aware of these batteries as hazards that can be life-changing and life-threatening,” Dr. Jatana stresses. “Advise them to keep all batteries stored in secure containers, out of reach or sight of children, and to check that all battery-powered electronics contain the batteries in a secured compartment that requires a tool to gain access.”

As a result of the recent study, the National Capital Poison Center has released new guidelines for the management of lodged button batteries in children ages 1 and older.

You can use the downloadable handout shown below in your practice to educate parents and caregivers about button battery injuries.

 

References:

  1. Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. The Laryngoscope. 2018 Jun 11. [Epub ahead of print]
  2. Jatana KR, Rhoades K, Milkovich S, Jacobs IN. Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. The Laryngoscope. 2017 Jun;127(6):1276-1282.

Image credits: iStock (photo), Nationwide Children’s (infographic)