November 24, 2018

Drinking Honey Reduces Throat Damage after Swallowing Button Battery

Button batteries swallowed by children cause significant damage to the lining of the throat and esophagus and has the potential to cause significant swallowing difficulties both in the short-term due to mucosal injury as well as long-term issues from scarring. Serious damage can occur within 2 hours of battery ingestion and deaths have also occurred due to button battery ingestion. As such, any intervention that can be done to minimize mucosal damage from the moment of swallow until the button battery is removed surgically can profoundly improve outcomes.

According to researchers at the Children's Hospital of Philadelphia, honey along with a medication called sucralfate provided significant protective effects. Other liquids tested which did not help as much included apple juice, orange juice, Gatorade, Powerade, and pure maple syrup. Both honey and sucralfate neutralized tissue pH and created more localized and superficial injuries with a decrease in both full‐thickness and outward extension of injury in the deep muscle beyond the surface ulcer margins.

The researchers concluded that "in the crucial period between button battery ingestion and endoscopic removal, early and frequent ingestion of honey in the household setting and carafate in the clinical setting has the potential to reduce injury severity and improve patient outcomes." [Link]

Basically, if a child swallows a button battery, the parents should immediately have the child swallow 1 teaspoon of honey in the home as soon as possible... THEN drive the child to the hospital ER where sucralfate can be administered. These steps will minimize throat damage the button battery is causing until it can be removed.

Of note, a study performed to determine the average time to esophageal perforation showed that only 2% of perforations occurred within 24 hours after ingestion. Another 7.4% of perforations became evident 24 to 47 hours after ingestion, and 10.1% of perforations became evident 48 to 71 hours after ingestion. Perforations were evident by 3 days after ingestion in 26.8%, by 4 days in 36.9%, by 5 days in 46.3%, and by 9 days in 66.4%. It is important to note that this does not mean that removal can be delayed, because the period of peak electrolysis activity and battery damage occurs within the first 12 hours. Rather, this result means that adjunctive measures, such as administration of honey or sucralfate, can be safely taken and will likely benefit the patient because they may be able to coat the battery and prevent local hydroxide generation. 

As an aside, honey should NOT be given if the child is less than one years old due to risk of botulism.

pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope June 22, 2018.

Time to perforation for button batteries lodged in the esophagus. The American Journal of Emergency Medicine. Volume 37, Issue 5, May 2019, Pages 805-809
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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