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Honey…or Jam for Button Battery Ingestion?

May 17, 2024

Written by Jason Lesnick

Spoon Feed
This pig cadaver study argues that jam is a reasonable alternative (if honey and sucralfate are unavailable) to give patients while awaiting definitive endoscopic removal after button battery ingestion.

“I need the honey STAT! No? Okay, what about jam?”
We all know and fear the time-sensitive emergency of a button battery ingestion that can lead to severe alkaline esophageal burns (severe injury can occur within 2 hours). This interesting paper discusses two experiments using 33 pig cadaver models to test household items for potential ability to decrease burn severity.

Experiment 1 looked at esophageal mucosal segments where a button battery was placed onto the mucosa and saline, honey, jam, orange juice, yogurt, milk, and cola were applied q10 minutes for 6 applications. The authors then measured tissue pH q10 minutes and measured macroscopic ulceration size at 120 minutes. Experiment 1 showed honey and jam had a lower tissue pH at 120 minutes (8.0 and 7.1, respectively) compared to saline solution, with a pH of 11.9. Honey (0.24 cm2) and jam (0.37 cm2) also had smaller average areas of ulceration compared to saline (3.90 cm2).

The second experiment utilized an intact esophageal model where they inserted a battery into the lumen, then honey, jam, and saline q10 minutes for a total of 6 times. They measured tissue pH, macroscopic and histopathologic changes at 60, 90, and 120 minutes. Experiment 2 found honey and jam had statistically significantly lower average tissue pH at all compared timepoints relative to saline solution. Additionally, histologic changes were noted at 60 minutes in the saline group while honey and jam exhibited minimal-no changes until 120 minutes.

Figure 3 of original article showing mucosal damage after 120 minutes of battery exposure from experiment 1.

How will this change my practice?
The next time I am transferring a pediatric patient from a rural setting for emergent endoscopic removal, I will ask the accepting team if they want us to give the patient honey and/or sucralfate. The National Poison Center Guidelines and European Societies for Pediatric Gastroenterology, Hepatology, and Nutrition already recommend honey or sucralfate if less than 12 hours from ingestion, based on many other animal studies. Their recommended dose is 10 mL q10 minutes up to 6 doses of honey and 3 doses of sucralfate (avoid honey if <1 year old or suspected perforation, mediastinitis, dysphagia, sepsis, or allergy). This paper adds to the literature that jam is a reasonable second line treatment option if honey is unavailable or contraindicated.

Editor’s note: We don’t often cover preclinical, animal-based studies. However, this could save a child’s life. Now we know – if we’re out of honey – jam also works as a potential temporizing measure. ~Clay Smith

Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model. Ann Emerg Med. 2024 Apr;83(4):351-359. doi: 10.1016/j.annemergmed.2023.08.018. Epub 2023 Sep 19. PMID: 37725021.

What are your thoughts?