・リチウム電池を誤飲した幼児に重大な健康障害や死亡例があるそうです。まずは、medlineのabstractをご覧ください↓

Pediatrics.2010 Jun;125(6):1168-77. Epub 2010 May 24.

Emerging battery-ingestion hazard: clinical implications.

Litovitz T, Whitaker N, Clark L, White NC, Marsolek M

National Capital Poison Center, 3201 New Mexico Ave, Suite 310, Washington, DC 20016, USA. toby@poison.org

Abstract

OBJECTIVES: Recent cases suggest that severe and fatal button battery ingestions are increasing and current treatment may be inadequate. The objective of this study was to identify battery ingestion outcome predictors and trends, define the urgency of intervention, and refine treatment guidelines.

METHODS: Data were analyzed from 3 sources: (1) National Poison Data System (56535 cases, 1985-2009); (2) National Battery Ingestion Hotline (8648 cases, July 1990-September 2008); and (3) medical literature and National Battery Ingestion Hotline cases (13 deaths and 73 major outcomes) involving esophageal or airway button battery lodgment.

RESULTS: All 3 data sets signal worsening outcomes, with a 6.7-fold increase in the percentage of button battery ingestions with major or fatal outcomes from 1985 to 2009 (National Poison Data System). Ingestions of 20- to 25-mm-diameter cells increased from 1% to 18% of ingested button batteries (1990-2008), paralleling the rise in lithium-cell ingestions (1.3% to 24%). Outcomes were significantly worse for large-diameter lithium cells (> or = 20 mm) and children who were younger than 4 years. The 20-mm lithium cell was implicated in most severe outcomes. Severe burns with sequelae occurred in just 2 to 2.5 hours. Most fatal (92%) or major outcome (56%) ingestions were not witnessed. At least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries extended after removal, with unanticipated and delayed esophageal perforations, tracheoesophageal fistulas, fistulization into major vessels, and massive hemorrhage. CONCLUSIONS: Revised treatment guidelines promote expedited removal from the esophagus, increase vigilance for delayed complications, and identify patients who require urgent radiographs.

恐い話です。飲み込んで2時間で重篤な障害が出ているそうです。それでもって、子供の場合は、飲み込んだかどうかも分からないので、診断のつけようがないですね。小児救急恐い。

・次に、この記事を配信してくれた、Jounal WATCHの記事を貼り付けておきます。

Alarming Rise in Major Complications from Button Battery Ingestions

Ingestion of large button batteries, particularly lithium cells, accounts for the increase in poor outcomes.

To describe recent trends in button battery ingestions, investigators collected data from the National Poison Data System (NPDS; 56,535 cases reported during 1985–2009), the National Battery Ingestion Hotline (NBIH; 8161 cases during 1990–2008), and all 73 major (life-threatening or disabling) and 13 fatal cases ever reported in the medical literature or to the NBIH.

NPDS data showed no consistent trend in annual frequency of button battery ingestions. However, the proportion of major or fatal cases increased 6.7-fold between the first 3 years (1985–1987) and last 3 years (2007–2009). Children younger than 6 years accounted for 68% of NPDS cases and 62% of NBIH cases; all NBIH fatalities and 85% of major cases were in patients younger than 4 years. In logistic regression analysis of NBIH data, predictors of poor outcome were large battery diameter (20–25 mm; odds ratio, 24.6), age <4 years (OR, 3.2), and ingestion of more than one battery (OR, 2.1).

During 2000–2009, 92% of major and fatal cases were from ingestion of 20-mm lithium cells. Injuries (e.g., severe burns, esophageal stenosis, bilateral vocal cord paralysis) occurred as soon as 2 hours after ingestion. Most major and fatal cases occurred in children <4 years old (92%) and were unwitnessed (56%), and many unwitnessed cases were initially misdiagnosed (46%). The authors present a management algorithm that recommends endoscopic removal of esophageal button batteries within 2 hours of ingestion.

Comment: These data are sobering. Physicians should keep button cells high on the list of differential diagnoses for any child who presents with airway obstruction or wheezing, drooling, vomiting, chest discomfort, difficulty swallowing or refusal to eat, or choking or coughing while eating or drinking. Once an esophageal button battery is identified, consultants must be mobilized for emergent removal.

— Katherine Bakes, MD

Published in Journal Watch Emergency Medicine　June 25, 2010

お父さん、お母さん。煙草のみでなく、電池も子供の手の届くところに置いちゃだめですよ。

以下日記

・本日も早朝回診後、外来。午後は会議のレンチャンでした。幸いなことに重症の患者さんが今いないので、本日は早く帰宅できました。風呂入っていたら、次女から電話で雨が降っているから駅まで迎えに来てと。何と、次女は傘を持たずに大学に行っとりました。晴れの日でも折り畳み傘を持ちなさいとお説教しました。

・昨日から寝床で『大作曲家たちの履歴書』（中公文庫。三枝成彰）という本を読みだしました。昨日は、リスト、ワーグナー、ベルリオーズを読みましたが、結構面白いですね。リストって、人が良かったのですね。ワーグナーは、思った通り自己中なのですが、作曲家としては私がおもっていたより偉大なんですね。当然ですが、人の良さと作曲のすごさは比例しない。本日は、マーラーを読みましょう。