button battery ingestion 06.05.2015
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Morning Report
Laura Lascurain, M.D. June 05, 2015
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HPI
3 year old preiously !ealt!y "oypresents #it! c!est pain
$tarted so%eti%e today Points to !is upper a"do%en and
sternu% #!en as&ed #!ere !is pain is $ee%s to "e in constant pain
'ot associated #it! position $pent t!e day at !o%e #it! !is Mo%,
sister () %ont!s* and "rot!ers (5 and +*
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R$
$lig!t -eer yesterday to 3.1 noted #!en!e #as laying around a lot
'o !eadac!e 'o r!inorr!ea. /oug!s inter%ittently today Re-using to eat or drin& since pain started,
"ut urinating t!is M. 'o e%esis, Mo%t!in&s !e stooled yesterday
'o trou"le using etre%ities, "ut !as not"een ery actie #it! t!e pain
'o ras!es
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Past Medical History ull ter% '$D #ent !o%e on ti%e #it! Mo% Hospitali4ed #it! R$ "ronc!iolitis 1 'o surgeries, c!ronic conditions, %edications $ocially, lies a"out an !our a#ay on a -ar% #it! Mo%,
Dad, and si"lings. ats a 6sugar -ree7 diet and usesessential oils, does not drin& tap #ater
'ot in presc!ool. Just co%pleted toilet training Deelop%entally, can spea& in sentences o- a"out 5
#ords, #al&s stairs, &ic&s "alls, scri""les circles and
lines. n8oys playing soccer and playing #it! t!e-a%ily9s -ar% ani%als (#!ic! include goat, s!eep, co#s,!orses, and dogs*
'o pertinent -a%ily !istory
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a% itals: ; 3.5, P 1?5, R 25, )3@ R Aen: #ell appearing "ut sits Buietly and is %ini%ally cooperatie,
appears in pain, nor%al !a"itus, #ell groo%ed H';: slig!tly dry %ucus %e%"ranes, C%ucus in post. P "ut no
ot!er lesions, no LD
R$P: slig!tly la"ored "reat!ing #it! interspersed dry coug!s, =$distant "ut sy%%etric, #it!dra#s to touc!
/: tacc!ycardic #it! regular r!yt!%, grade III>I $M !eard "est atLL$=, e% pulses palpa"le "ut 1C, /R E3 sec
=D: !ypoactie =$, tender to palpation "ilateral upper Buadrants#it! F%ild guarding, no re"ound
AG>R/;L: ;anner 1 nor%al %ale, anus nor%al tone and sensation ;: #ell per-used "ut coolis! to t!e touc!, no clu""ing $I': no ras!es 'GR: alert, oriented, /' grossly intact, sensation and tone
appear nor%al, gait is nor%al (sa# !i% #al& in #it! parents*
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Dierential t!er
• Muc!uasen "y proy Respiratory
• ;rac!eal =
• P!aryngitis• Reactie ir#ay Disease
• Pneu%ot!ora
• Pneu%onia (aspiration ersus AI
• Peptic Glcer
• sop!agitis
• "struction
• Intussception
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=utton =attery Ingestion
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-ter Re%oal
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oreign =odies in sop!agus: K!ic!are urgentF
=utton =atteries $!arp o"8ects #it! t!e 6pointy part7
going -or#ard Multiple %agnets Hig! Po#ered Magnets Long o"8ects (5 c%*
ir#ay co%pro%ise Ina"ility to s#allo# secretions (reectsesop!ageal o"struction*
eer, a"do%inal pain, e%esis C>: o"8ects %ade o- lead
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Swallowed Magnets
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K!at '; to do
oid :• Ipecac ad%inistration (ineectie*.
• =lind "attery re%oal #it! a "alloon cat!eter or
a %agnet aOed to a nasogastric tu"e (can9tdeter%ine etent o- in8ury*.
• =lood or urine concentrations o- %ercury orot!er "attery ingredients (unnecessary*.
•
/!elation (unnecessary*.• Laaties (ineectie* or polyet!ylene glycol
electrolyte solution (unproen eectieness andun&no#n i- solution en!ances electrolysis*.
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/oin s =utton =attery: Ho# #ill I&no#F
/oins %uc! %ore co%%only ingested"ut you do not #ant to %iss a "utton"attery ingestion
Ma&e t!e patient 'P #!ile getting rays
Loo& -or t!e 6step o7 on lateral R 6'egatie'arro#'ecrotic7
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Coin or Button BatterySwallowed?
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Coin or Button BatterySwallowed?
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Coin or Button BatterySwallowed?
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Coin or Button BatterySwallowed?
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Coin or Button BatterySwallowed?
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Mec!anis%s o- In8ury o- ==
Aeneration o- an eternal electrolyticcurrent t!at !ydroly4es tissue uids andproduces !ydroide at t!e "attery9s
negatie pole Leakage o- al&aline electrolyte
(!ydroide* P!ysical pressure on ad8acent tissue
(#!ic!, alone, does not cause signicantin8ury*.
/auses liBue-actie necrosis
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K!at i- an 6urgent7 o"8ect passest!roug! t!e pylorusF
ReBuire surgical re%oal #it!sy%pto%s
$!ould "e #atc!ed closely: considerad%ission and serial radiograp!s
;!ere can "e later, serious aderseeents related to een "enign -oreign
"odies so %a&e sure patients !ae-ollo# up
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Learning Points
=utton "atteries need to "e re%oed$PQ Ma&e t!e patient 'P and callAI.
l#ays consider a "utton "atteryingestion (or een coingestionQ*
ou s!ould &no# #!at needs to "e
re%oed urgently and #!at #ill li&elypass (!int: coins usually pass*
Ma&e sure patients !ae good -ollo#
up
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inal ;!oug!t
6/linicians %issed t!e diagnosis o- a"attery lodged in t!e esop!agus in atleast 2+@ o- %a8or outco%e and54% of fatal cases "ecause o-nonspecic presentations, especiallyin un#itnessed ingestions.7
Emerging Battery-Ingestion Hazard: Clinical ImplicationsIn Pediatrics, 2010
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Re-erences
Litoit4 ;, K!ita&er ', /lar& L, et al. %erging "atteryingestion !a4ard: clinical i%plications. Pediatrics 2010S 125:11?.
Kyllie R. oreign "odies in t!e gastrointestinal tract.
/urr pin Pediatr 200?S 1:5?3.
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