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Objectives/Hypothesis
Button battery (BB) injuries continue to be a significant source of morbidity and mortality, and there is a need to confirm the mechanism of injury for development of additional mitigation strategies.
The Laryngoscope
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Broncho-Esophagology
Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal
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Presented at the American Broncho-Esophagological Association Meeting, Chicago, Illinois, U.S.A., May 18–19, 2016.
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This study was awarded the 2016 Seymour Cohen Award in Pediatric Laryngology and Broncho-Esophagology.
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k.r.j. serves as a medical consultant and provides expert witness testimony. k.r.j. and i.n.j. serve in leadership positions on the national Button Battery Task Force, affiliated with the American Academy of Pediatrics and American Broncho-Esophagological Association.
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The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Abstract
Study Design
Cadaveric piglet esophageal model.
Methods
Lithium, silver oxide, alkaline, and zinc–air BBs were placed in thawed sections of cadaveric piglet esophagus, bathed in normal saline. Severity of gross visual burn, pH, and temperature were recorded every 30 minutes for 6 hours. In other esophageal tissue specimens, the lithium BB was removed after 24, 36, and 48 hours and the site was irrigated with either 0.25% or 3% acetic acid. Separately, ReaLemon® juice, orange juice, Coke®, Dasani® water, Pepsi®, and saline were infused over a vertically suspended esophagus with a CR2032 lithium battery every 5 minutes for 2 hours while tissue temperature and pH were measured.
Results
A gradual rise in tissue pH and minimal change in temperature was noted for all BBs. ReaLemon® and orange juice applied every 5 minutes were most effective at neutralization of tissue pH with minimal change in tissue temperature. After BB removal (24, 36, 48 hours), irrigation of esophageal tissue specimens with 50–150 mL 0.25% acetic acid neutralized the highly alkaline tissue pH.
Conclusions
BB appear to cause an isothermic hydrolysis reaction resulting in an alkaline caustic injury. Potential new mitigation strategies include application of neutralizing weakly acidic solutions that may reduce esophageal injury progression.
Level of Evidence
NA Laryngoscope, 127:1276–1282, 2017