Disk Battery Ingestion Clinical Presentation

Updated: Dec 28, 2015
  • Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Asim Tarabar, MD  more...
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Presentation

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.

In 56% of the cases where a major outcome occurred in children less than 4 years old, the ingestion was unwitnessed. [1] Of these, 46% were initially misdiagnosed (including being mistaken for a coin). Most of the initially misdiagnosed cases involved failure to recognize the ingestion due to nonspecific symptoms.

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 garage door openers, games and toys, calculators, cameras, lighted key chains, fishing bobs, flashing jewelry, musical greeting cards or books, and digital thermometers.

Most children who ingest a disk battery remain asymptomatic and pass the battery in their stool within 2-7 days. [5] 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 due to their larger size and increased likelihood of impaction as well as their ability to generate more current. [6] Symptoms reportedly associated with the lodging of the battery in the GI tract include the following (in order of decreasing frequency) [6] :

  • Vomiting (occasionally bloody)
  • Abdominal pain
  • Discolored stools (eg, green)
  • Fever
  • Diarrhea
  • Rashes
  • Respiratory distress
  • Others - Irritability, food refusal, dysphagia, coughing or gagging, anorexia, increased salivation (often with black flecks in the saliva), retrosternal discomfort, and abdominal pain
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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.

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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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