eMedicine Specialties > Emergency Medicine > Gastrointestinal
Disk Battery Ingestion
Updated: Feb 11, 2008
Introduction
Background
Disk batteries are small, coin-shaped batteries used in watches, calculators, and hearing aids. The vast majority of disk battery ingestions occur when curious children explore their environment.
Early published case reports of ingestion of disk batteries were concerned with serious sequelae (eg, esophageal perforation, aortic perforation with exsanguination, tracheoesophageal fistulae). From these reports, recommendations were made for aggressive management, including surgical removal. Information gained from the National Button Battery Investigation Study combined with more recent case reports and series involving successful conservative management has shown that these ingestions usually are benign.
Disk batteries
Disk batteries are formed by compacting metals and metal oxides on either side of an electrolyte-soaked separator. The unit is then placed in a 2-part metal casing held together by a plastic grommet (see Media file 1). The grommet electrically insulates the anode from the cathode. The metal undergoes oxidation on one side of the separator, while the metal oxide is reduced to the metal on the other side, producing a current when a conductive path is provided.
Disk batteries contain mercury, silver, zinc, manganese, cadmium, lithium, sulfur oxide, copper, brass, or steel. These are the components of the anode, cathode, and case containing the battery. Disk batteries also contain sodium hydroxide or potassium hydroxide to facilitate the electrochemical reaction through the separator. In a series of 2382 battery ingestions in 1589 patients in which the type of battery was known, 30% were manganese dioxide, 29% were zinc/air, 25% were mercuric oxide, 17% were silver oxide, and fewer than 1% were lithium.1
Disk batteries vary in diameter from 7.9-23 mm and in weight from 1-10 g. The diameter of ingested disk batteries is less than 15 mm in 97% of cases. Most frequently ingested sizes are 11.6 mm (63%) and 7.9 mm (30%).
Pathophysiology
Disk batteries do not usually cause problems unless they become lodged in the gastrointestinal (GI) tract. The most common place disk batteries become lodged, resulting in clinical sequelae, is the esophagus. Batteries that successfully traverse the esophagus are unlikely to lodge at any other location.
Batteries pass through the GI tract in a relatively short period of time: 23% within 24 hours, 61% within 48 hours, 78% within 72 hours, and 86% within 96 hours. Only 1% of batteries take more than 2 weeks.
The likelihood that a disk battery will lodge in the esophagus is a function of the patient's age and the size of the battery. Disk batteries of 16 mm have become lodged in the esophagi of 2 children younger than 1 year. Older children do not have problems with batteries smaller than 21-23 mm. For comparison, a dime is 18 mm, a nickel is 21 mm, and a quarter is 24 mm.
Esophageal damage can occur in a relatively short period of time when a disk battery is lodged in the esophagus. Liquefaction necrosis may occur because sodium hydroxide is generated by the current produced by the battery (usually at the anode). Perforation has occurred as rapidly as 6 hours after ingestion.
Frequency
United States
An estimated minimum of 2100 cases of disk battery ingestion occur per year (see Media file 2).
Sex
Male predominance (59%) is observed in disk battery ingestions.
Age
- Children younger than 6 years account for 66% of ingestions, with a peak incidence in those aged 1 and 2 years.
- A second peak is observed in adults older than 60 years, with 10.3% of cases occurring in patients aged 60-89 years. Elderly patients are more likely to have batteries lodged in the small or large bowels. Patients older than 79 years account for only 4.6% of ingestions; in 31% of those cases, the battery lodges in the bowels.
Clinical
History
- Occasionally, the ingestion of a disk battery is observed. More than one half of disk battery ingestions (53%) occur immediately following removal from a product. Another 41% involve batteries that are loose, either sitting out or discarded. More than one battery is ingested in 8.5% of the episodes.
- Powering hearing aids is the most common intended use of the ingested batteries (44.6%). In 32.8% of the cases, the child removed the battery from his or her own hearing aid. Watch batteries account for 16% of ingestions. Other sources of disk batteries that are ingested include games and toys, calculators, cameras, lighted key chains, fishing bobs, flashing jewelry, musical greeting cards or books, and thermometers.
- Most children who ingest a disk battery remain asymptomatic and pass the battery in their stool within 2-7 days. Only 10% of patients who ingest disk batteries report symptoms, which are predominantly minor GI problems.
- Rashes following disk battery ingestion have been reported infrequently and may be a manifestation of nickel hypersensitivity, as many disk batteries are nickel-plated.
- Lodging of lithium cells is associated with disproportionately more adverse effects than lodging of other types of batteries. Symptoms reportedly associated with the lodging of the battery in the GI tract include the following:
- Coughing or gagging
- Dysphagia
- Retrosternal discomfort
- Vomiting, diarrhea, constipation, green stools, melena
- Hematemesis (occasionally)
- Abdominal pain
- Fever
- Anorexia
- Increased salivation (often with black flecks in the saliva)
Physical
- No physical examination findings are specific for patients who ingest disk batteries.
- Children with a battery lodged in the esophagus typically present with the following:
- Refusal to take fluids
- Increased salivation (often with black flecks in the saliva)
- Dysphagia
- Vomiting
- Hematemesis occasionally
- Patients may have airway compromise following disk battery ingestion.
- Hematochezia or abdominal tenderness suggests GI injury, possibly due to battery rupture.
- In one study, 9 of 25 patients (36%) with batteries in the esophagus were asymptomatic; therefore, do not rely on the lack of symptoms as an indicator to rule out esophageal lodgment.
Causes
- When a disk battery is in an acid environment, an electrochemical reaction occurs that leads to dissolution of the cathode, primarily in the crimp area. Not surprisingly, batteries that become lodged in the stomach corrode and fragment more frequently than other ingested batteries. Corrosion and fragmentation are most common in batteries that lodge in the stomach for more than 48 hours.
- Approximately 2-3% of ingested batteries fragment within the GI tract, and 10.7% demonstrate severe crimp dissolution.
- Mercuric oxide cells are substantially more likely to fragment than batteries of other chemical compositions.
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References
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Palmer O, Natarajan B, Johnstone A, Sheikh S. Button battery in the nose--an unusual foreign body. J Laryngol Otol. Oct 1994;108(10):871-2. [Medline].
Sheikh A. Button battery ingestions in children. Pediatr Emerg Care. Aug 1993;9(4):224-9. [Medline].
Tong MC, Van Hasselt CA, Woo JK. The hazards of button batteries in the nose. J Otolaryngol. Dec 1992;21(6):458-60. [Medline].
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Further Reading
Keywords
battery ingestion, disk battery, watch battery, calculator battery, hearing aid battery, esophageal perforation, aortic perforation with exsanguinations, tracheoesophageal fistulae, esophageal damage, endoscopic retrieval, National Button Battery Ingestion Hotline, swallowed disk battery, button battery
