Disk Battery Ingestion

Updated: Oct 25, 2022
  • Author: Bobak Zonnoor , MD, MMM; Chief Editor: David Vearrier, MD, MPH  more...
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Disk batteries are small, coin-shaped batteries used in watches, calculators, toys, small electronic devices, musical greeting cards, 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 fistula). 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. [1]

Fatal cases or those with major sequelae usually involve esophageal or airway battery lodgment. [2, 3]

For patient education resources, see First Aid and Injuries Center, as well as Battery Ingestion.

Disk batteries

Disk batteries are formed by compacting metals and metal oxides on either side of an electrolyte-soaked separator. [1] The unit is then placed in a 2-part metal casing held together by a plastic grommet (see the image below).

Cross-section of a typical disk battery. Cross-section of a typical disk battery.

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 56,535 battery ingestions from 1985-2009 in which the type of battery was known in 57.7% of the cases, 42% were manganese dioxide, 32% were zinc-air, 13% were silver oxide, and 9% were lithium (up from 1.3% in 1900-1993). [2] In 2008, 24% of the batteries ingested were lithium cells; an upward trend that started in the late 1990s with a corresponding drop in the number of mercuric oxide cells. See the image below.

Changes in chemical systems of ingested disk batte Changes in chemical systems of ingested disk batteries from 1990-2008.

Disk batteries vary in diameter from 7.9-23 mm and in weight from 1-10 g. Known diameters of ingested disk batteries are as follows: 11.6 mm (55% of cases), 7.8-7.9 mm (31% of cases), 20 mm or more (6.7% of cases), 5.8 mm (3% of cases). Cases of large diameter (≥20 mm) disk battery ingestions increased from 1% of cases from 1990-1993 to 18% of cases in 2008. [2] See the image below.

Changes in the diameter of disk batteries ingested Changes in the diameter of disk batteries ingested from 1990-2008.

From 2000-2009, 92% of disk batteries from fatal ingestions or those with major outcomes were 20-mm lithium cells. Most were imprint code CR 2032 (71%) or CR 2025 (21%). [2] "CR" represents the battery chemistry, "20" is the diameter, and "32" indicates the thickness (3.2 mm) of the battery. See the image below.

20 mm CR 2032 lithium cell disk battery shown with 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).


Disk batteries do not usually require medical attention unless they become lodged in the digestive tract, nose, or ears. The esophagus is the most common place disk batteries become lodged, resulting in clinical sequelae. The likelihood of a disk battery lodging in the esophagus is a function of the patient's age (very young or old), esophagus and disk battery size (diameter in mm), and battery type (chemical content).

Battery size and type are the two most important predictors of a clinically significant outcome. The larger the battery, the increased likelihood of it becoming lodged and thus causing clinical issues. Although the culprit size varies (20-25 mm), a disk battery size of 20 mm is the most commonly problematic. However, disk battery diameters of 16 mm have become lodged in the esophagi of children younger than 4 years. [2] Older children generally do not have problems with disk batteries smaller than 21-23 mm. For comparison, the diameter of a dime is 18 mm, that of a nickel is 21 mm, and that of a quarter is 25 mm.

When the diameter of the battery is known, 94% of fatal cases or those with major outcomes involve batteries 20 mm or more in diameter. Lithium-containing batteries are more commonly associated with clinically significant outcomes than all other chemical types combined. Of ingested batteries that are 20-25 mm diameter, 99% are lithium cells.

Esophageal damage can occur in a relatively short period of time (2-2.5 h) when a disk battery is lodged in the esophagus. [2, 4]

Endoscopic view of disk battery in esophagus of a Endoscopic view of disk battery in esophagus of a child demonstrating esophageal burns.

Batteries that successfully traverse the esophagus are unlikely to lodge at any other location. Batteries pass through the gastrointestinal 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.

Liquefaction necrosis may occur because sodium hydroxide is generated by the current produced by the battery (usually at the anode which is the flat surface without an imprint code or "+" sign). Perforation has occurred as rapidly as 6 hours after ingestion. The 20 mm lithium batteries are 3V cells as compared with 1.5V for other disk batteries. They have a higher capacitance and generate more current, which results in the production of more hydroxide more rapidly. [2] The most severe esophageal burns (and subsequent perforations) occur adjacent to the negative battery pole (anode). Injury can continue after endoscopic battery removal for days to weeks due to residual alkali or weakened tissues.

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.



United States data

From 1985-2017, 83,469 disk battery ingestions were reported to the National Poison Data System. [5] Clinically significant outcomes (moderate, major, or fatal) occurred in only 1.3% cases from 1985-2009. [2] The number of disk battery injuries trended upward as their use became increasingly common in household items, but has started to slowly decline. In 2017, 3,244 disk battery ingestions were reported to the National Poison Data System compared to 3,758 in 2007. However, the percentage of significant outcomes (moderate, major, and fatal) has increased from 2.6% to 4.4% in the same time period, likely owing to the increased use of lithium cells. [5, 6]

International data

Gerner at al analyzed the incidence of disk battery ingestions in children younger than 5 years in Germany from 2011 to 2016, including 258 cases reported to the Freiburg poison center and survey data collected from pediatric gastroenterologists and surgeons. [7] The battery was located in the esophagus in 116 cases; 47 children developed severe complications and 5 children died.

Krom et al conducted a retrospective survey on the incidence of significant complications of disk battery ingestions in the Netherlands from 2008 to 2016. They found 16 cases with serious and fatal outcomes, all in children younger than 5 years; 75% of the batteries were more than 20 mm. [8]

Sex- and age-related demographics

Male predominance (59%) is observed in disk battery ingestions.

Children younger than 6 years account for 61% of ingestions, with a peak incidence in those aged 1 and 3 years. All fatalities from 1985-2009 and 85% of cases with major outcomes occurred in children who were younger than 4 years old and were often nonverbal. [2]

A second peak is observed in adults older than 60 years, with 10.3% of cases occurring in patients aged 60-89 years. [9] 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.



The usual outcome of disk battery ingestions is an uneventful passage. More than 97% of disk battery ingestions have only mild effects or none at all. See the image below.

NPDS button-battery ingestion frequency and severi NPDS button-battery ingestion frequency and severity (for moderate, major, and fatal outcomes), according to year.


Complications in major outcome cases have included tracheoesophageal fistulas, other esophageal perforations, esophageal strictures requiring repeated dilations, vocal cord paralysis from recurrent laryngeal nerve damage, mediastinitis, pneumothorax, pneumoperitoneum, tracheal stenosis, tracheomalacia, aspiration pneumonia, empyema, lung abscess, and spondylodiscitis. [2]

The possibility of heavy metal poisoning, especially from mercury, has been considered. A typical battery may contain from 15-50% mercuric oxide, leading to possible ingestion of as much as 5 g of mercury, a potentially lethal amount. This theoretical threat of toxicity has not been borne out by clinical experience. In a series of 2382 battery ingestions, no clinical evidence of mercury toxicity was observed. [10]

A spent cell, which no longer has enough power for the intended device, may still maintain considerable residual voltage. However, new cells are 3.2 times likely to be associated with clinically significant outcomes than spent cells. [2]

Retrograde movement of the battery from the stomach to the esophagus has been reported as a complication of use of ipecac syrup, necessitating emergent endoscopic removal. If the battery produces a mucosal burn, a theoretical risk exists of battery aspiration and perforation of the esophagus or stomach.

Deaths due to button battery ingestion are rare, but the numbers have been on the rise. [5, 7, 8, 11] From 1985 to 2009, only 13 of 56,535 reported button battery ingestions were fatal (0.02%). [2] Ingestion of a disk battery was initially missed by providers in 7 (54%) of the those cases due to no initial history of ingestion and nonspecific presenting symptoms such as vomiting, fever, lethargy, poor appetite, irritability, wheezing, cough, and/or dehydration. Exsanguination due to esophageal fistula occurred in 9 cases (69%), of which 7 were aortoesophageal. [2] From 2014 to 2017, 12 fatalities were reported in 13,094 cases (0.09%). [5]

A 2022 report of US emergency department visits from 2010-2019 for battery ingestions by children found a two-fold increase in such visits over the decade 2010-2019 compared to 1990-2009, of which 85% involved disk batteries. [12]