• Angela L Chiew, Calvin S Lin, Dan T Nguyen, Felicity A W Sinclair, Betty S Chan, and Annalisa Solinas.
• Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia. Electronic address: angela.chiew@health.nsw.gov.au.
• Ann Emerg Med. 2024 Apr 1; 83 (4): 351359351-359.

Study ObjectiveButton battery ingestion can cause alkaline esophageal injury. There is interest in first-aid household products to neutralize the injury. The objective was to investigate which household products are effective at reducing button battery injury.MethodsTwo cadaveric porcine experiments were performed. Experiment 1 utilized esophageal mucosal segments. A button battery (3VCR2032) was placed onto the mucosa, and substances (saline control, honey, jam, orange juice, yogurt, milk, and cola) were applied every 10 minutes for 6 applications. Tissue pH was measured every 10 minutes, and macroscopic ulceration size was assessed at 120 minutes. Experiment 2 used an intact esophageal model with a battery inserted into the lumen and jam, honey, and saline irrigation as per experiment 1. Tissue pH, macroscopic and histopathology changes were evaluated at 60, 90 and 120 minutes.ResultsIn experiment 1, only honey and jam had a lower mean tissue pH at 120 minutes (8.0 [standard deviation [SD] 0.9, n=12] and 7.1 [SD 1.7, n=12], respectively) compared to saline solution 11.9 (SD 0.6, n=6, P<.0001). Both honey (0.24 cm2, SD 0.17) and jam (0.37 cm2, SD 0.40) had smaller mean areas of ulceration compared to saline solution (3.90 cm2, SD 1.03, P<.0001). In experiment 2, honey and jam had significantly lower mean tissue pH at all timepoints compared to saline solution. Histologic changes were evident at 60 minutes in the saline group, whereas honey and jam exhibited no or minimal changes until 120 minutes.ConclusionsHoney and jam were able to neutralize injury caused by a button battery resulting in a smaller area of ulceration. Jam should be further explored as a possible first-aid option as an alternative to honey in suspected button battery ingestion prior to definitive management.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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