Button Battery Ingestion

Aka: Button Battery Ingestion, Button Battery

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II. Types

  1. Disc batteries (especially Lithium batteries)

III. Epidemiology

  1. Most common in toddlers
  2. Screen adolescents Button Battery Ingestions for Suicidality

IV. Precautions

  1. Button batteries leak alkaline agents and cause liquifaction necrosis when in contact with tissue
  2. Risk of voltage burn or corrosive injury
    1. Serious esophageal burns occur within 2 hours (even within 30 min)
      1. High risk of Esophageal Perforation in first 6 hours
    2. Tomaszewski (2016) Household Toxins Lecture, ACEP PEM Conference, attended 3/8/2016

V. Symptoms

  1. Symptomatic in two thirds of children

VI. Imaging

  1. XRay
    1. Appears as double ring similar to 2 stacked coins (stack sign) or poker chip on XRay

VII. Management: Ingested Button Battery

  1. Adjunctive management
    1. Sucralfate
    2. Honey (in age >1 year)
      1. Give 10 ml every 10 minutes while awaiting upper endoscopy
    3. References
      1. Soto (2018) Am J Emerg Med 37(5):805-809 +PMID:30054113 [PubMed]
  2. Button Battery in Esophagus
    1. Requires emergent upper endoscopy for removal (typically gastroenterology)
      1. Remove within 2 hours of ingestion
      2. Initiate early, emergent transfer if endoscopy not available at facility
    2. Exception
      1. Healthy, asymptomatic child >12 years old AND
      2. Single battery <12 mm in size without magnet
  3. Button Battery distal to Esophagus
    1. Symptomatic Button Battery or magnet coningestion
      1. Remove Button Battery immediately
    2. Asymptomatic button batteries below the Esophagus (e.g. Stomach)
      1. May attempt removal with endoscopy if in Stomach
      2. May be followed with serial XRay
      3. Expect to pass through pylorus within 48 hours and out with stool by 72 hours (up to 10-14 days)
      4. Large battery >20 mm
        1. Allow 48 hours to pass if asymptomatic (4 days if age < 6 years)
      5. Coningested battery and magnet
        1. High risk of magnet entrapping battery against mucosa, resulting in intestinal perforation risk
        2. Remove regardless of location (distal to Esophagus, Stomach)

VIII. Management: Other Button Battery foreign body involvement

  1. See Ear Foreign Body
  2. See Nasal Foreign Body
  3. Remove Button Battery as soon as possible
  4. Do not get the battery wet (moisture increases alkaline leakage and tissue damage)
  5. Use blunt object for removal (do not use a sharp instrument)

IX. Complications

  1. Aortoesophageal fistula
  2. Esophageal Stricture
  3. Pneumothorax
  4. Pneumomediastinum

X. Prognosis

  1. Children die from unrecognized Button Battery Ingestions (esp. unwitnessed in age under 3 years)

XI. Resources

  1. National Poison Control Center Protocol
    1. https://www.poison.org/battery/guideline

XII. References

  1. Claudius in Herbert (2017) EM:Rap 17(11):3-5
  2. Litovitz (2010) Pediatrics 125(6): 1178-83 +PMID:20498172 [PubMed]

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