Laboratory Studies
Consider obtaining blood and urine mercury levels only if a mercury-containing cell has been observed to fragment in the gastrointestinal tract or if radiopaque droplets are observed in the gut on radiographs.
Imaging Studies
Radiography is indicated to confirm the ingestion and to establish the location of ingested disk batteries. Disk batteries have a relatively characteristic appearance on radiograph. When viewed from above, they appear much like a coin; however, a double density is often present. When viewed on edge, a much more rounded edge with a step off at the junction of the cathode and anode is seen (see the image below).
Lateral radiographic appearance of a 7.9-mm disk battery. Photographed by Daniel J. Dire, MD.
Batteries located in the esophagus on initial radiographs frequently (28%) pass into the stomach spontaneously.
Radiopaque droplets in the gut may be found on radiograph in patients with fragmented mercuric oxide cells.
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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.
