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. [9] 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. [2] 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. [13, 14] 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. [15] Symptoms reportedly associated with the lodging of the battery in the GI tract include the following (in order of decreasing frequency) [15] :
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Vomiting (occasionally bloody)
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Abdominal pain
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Discolored stools (eg, green)
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Fever
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Diarrhea
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Rashes
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Respiratory distress
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Others - Irritability, food refusal, dysphagia, coughing or gagging, anorexia, increased salivation (often with black flecks in the saliva), retrosternal discomfort, and abdominal pain
Physical Examination
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:
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Refusal to take fluids
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Increased salivation (often with black flecks in the saliva)
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Dysphagia
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Vomiting
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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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Cross-section of a typical disk battery.
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Exposures to disk batteries reported to the American Association of Poison Control Centers, 1986-2009.
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Lateral radiographic appearance of a 7.9-mm disk battery. Photographed by Daniel J. Dire, MD.
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Recommended management algorithm for patients with disk battery ingestions. Notes: (1) Serum mercury levels and chelation therapy should be reserved for patients who develop signs of mercury toxicity, not simply because mercury is noted on radiograph. (2) Acute abdomen, tarry or bloody stools, fever, and persistent vomiting. (3) Disk batteries in the esophagus must be removed. Endoscopy should be used if available. The Foley catheter technique may be used if the ingestion is less than 2 hours old but not if more than 2 hours old because it may increase the damage to the weakened esophagus. (4) When the Foley technique fails or is contraindicated, the disk battery should be removed endoscopically. This may require transfer to a more comprehensive medical treatment facility.
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Radiograph of child 1 week after ingestion of a disk battery. The battery has passed into the rectum. Photographed by Daniel J. Dire, MD.
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Disk battery in the stomach of an 18-month-old child.
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Changes in the diameter of disk batteries ingested from 1990-2008.
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Changes in chemical systems of ingested disk batteries from 1990-2008.
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Endoscopic view of disk battery in esophagus of a child demonstrating esophageal burns.
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Endoscopic view of a nickel and penny in the esophagus of a child that was initially misdiagnosed as a disc battery.
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Lateral chest radiograph of a child with a nickel and penny adhered to each other in the upper esophagus initially misdiagnosed as a disk battery.
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20 mm CR 2032 lithium cell disk battery shown with a U.S. quarter: On the left is the cathode (positive pole) and on the right the narrower anode (negative pole).
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NPDS button-battery ingestion frequency and severity (for moderate, major, and fatal outcomes), according to year.
