Button Battery Ingestion 06.05.2015

8/20/2019 Button Battery Ingestion 06.05.2015

1/23

Morning Report

Laura Lascurain, M.D. June 05, 2015


2/23

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 +*


3/23

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


4/23

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


5/23

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*


6/23

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


7/23

=utton =attery Ingestion


8/23


9/23

-ter Re%oal


10/23

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


11/23

Swallowed Magnets


12/23

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*.


13/23

/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


14/23

Coin or Button BatterySwallowed?


15/23



16/23



17/23



18/23



19/23

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


20/23

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


21/23

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


22/23

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


23/23

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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Button Battery Ingestion 06.05.2015