Swallowed a Button Battery?
Each year, more than 3,000 people of all ages in the US unintentionally swallow miniature
disc or "button" batteries of the type used to power hearing aids, watches
and calculators.
The National Capital Poison Center in Washington, DC operates a 24/7 hotline
to assist
when one of these button batteries is swallowed. Most button cells pass through the body
and are eliminated in the stool. However, sometimes batteries can get "hung up
", and these are the ones that cause problems. A battery that doesn’t move through
the gut, especially one that lodges in the esophagus, may adhere to tissue and leak or
the electrical current passing through adjacent tissue can generate alkali. Chemical
burns may result. When a battery is swallowed, it is impossible to know whether it will
pass through or get "hung up", however a number of factors are known to
predict a bad outcome.
If anyone swallows a battery, this is what you should do:
| 1) |
Call the 24-hour National Button Battery Ingestion Hotline at
202-625-3333 IMMEDIATELY. Feel free to call collect. Your
physician or emergency room may also call. We are on duty 24-hours a day, 7 days a
week.
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| 2) |
If available, provide the battery identification number (from the package or from a
matching battery).
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| 3) |
An x-ray must be obtained immediately to be sure that the battery
has gone through the esophagus into the stomach. Do not wait for symptoms to
develop before getting an x-ray. If the battery remains in the esophagus, it must
be removed IMMEDIATELY. CAUTION: Batteries lodged in the esophagus can cause severe
burns in JUST 2 HOURS!! Battery removal is done with an endoscope; surgery is
rarely, if ever, indicated. Do NOT give ipecac.
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| 4) |
If a battery has moved beyond the esophagus, it can be expected to
pass by itself. Passage may take many days, or even months. Removal is NOT
indicated if the battery has passed beyond the esophagus and the patient is
asymptomatic. Once you are sure the battery is not in the esophagus, the patient
can be sent home to wait for the battery to pass. Watch for fever, abdominal pain,
vomiting or blood in the stools. Report these symptoms immediately to your physician
and to the Battery Hotline (202-625-3333).
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| 5) |
Watch the stools until the battery has passed.
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Interesting Facts about Button Battery Ingestions
| * |
Sixty-two percent of battery ingestions involve children under the
age of 5 years, with a peak incidence in 1- and 2-year-olds. However, many battery
ingestion cases involve adults!
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| * |
Nearly half (49%) of ingested batteries are cells intended for
hearing aids. Another 12% are for games and toys. Other sources include: watches and
clocks; calculators; camera equipment; beeping or lighted key chains; pocket
organizers; remote control devices; thermometers; phones; fishing bobbers; as well
as musical, beeping or lighted jewelry, greeting cards, shoelaces, shoes, clothing,
pens, doormats, and story books.
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| * |
A nearly 70% decline (over an 8-year period) in the percentage of
ingested batteries that come from games and toys reflects industry efforts to
secure the battery compartments of these products so that small children cannot
easily open them.
|
| * |
Nearly 25% of batteries are swallowed because they are mistaken for
medicines or pills.
|
| * |
In 8.5% of cases, multiple batteries are swallowed.
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| * |
Adults and older children often think of the mouth as a "third
hand", holding the battery there while working. The battery is inadvertently
swallowed if they are startled.
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| * |
Battery size is a predictor of lodgement; and battery lodgement,
whether in the esophagus, nose, or ear canal, is the sole consistent predictor of a
severe clinical outcome. Esophageal lodgement generally follows ingestions of larger
cells (20 to 23 mm in diameter). Button cells range in diameter from 6.8 mm to 23.0
mm; 97% of ingested cells are less than 15 mm in diameter. (The most popular
standard sizes are 7.9 mm and 11.6 mm).
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| * |
Leakage and/or the generation of an external current are the major
mechanisms of battery-induced tissue damage. Button cells often contain potassium
or sodium hydroxide electrolyte in concentrations up to 45%. Corrosive dissolution
of the crimp region surrounding the seal increases the risk of subsequent leakage.
An external current flowing between battery cathode and anode passes through
adjacent tissue causing hydrolysis of tissue fluids and local generation of
hydroxides. These hydroxides act on tissue the same way that an alkaline chemical
leaking from the battery would act. Thus batteries do NOT have to leak to cause
injury.
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| * |
Esophageal lodgement is the most serious clinical problem and can
lead to severe burns, perforation of the esophagus, stricture formation, and
occasionally death. It may manifest as vomiting, fever, pain on swallowing
ordifficulty swallowing, rapid breathing, irritability, or refusal of food.
Esophageal lodgement generally follows ingestions of larger cells (20 to 23 mm in
diameter), although exceptions occur. Even these larger cells often pass to the
stomach without consequence and cells with smaller diameters, as small as 7.9 to
11.6 mm, may lodge. It is because of the small but real risk of esophageal
lodgement that x-rays are recommended for all patients who swallow a battery.
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| * |
Mercury or other heavy metal poisoning is NOT a concern when button
batteries are swallowed. On May 13, 1996 federal legislation known as the "
Mercury-Containing and Rechargeable Battery Management Act" was enacted. This
legislation bans the sale of mercuric oxide button cells in the U.S. and prohibits
the use of intentionally introduced mercury in alkaline-manganese batteries,
limiting the mercury concentration in these batteries to 0.025%. But even when
mercuric oxide button cells are swallowed, the risk of mercury poisoning is
virtually nonexistent as the mercuric oxide is converted in the stomach to the much
less toxic elemental form of mercury.
|
| * |
Ingested lithium cells pose a higher risk due to their larger
diameter which makes them more likely to lodge in the esophagus and their greater
voltage which generates more local hydroxide when lodgement occurs.
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Treatment Essentials |
| Î |
Obtain a radiograph promptly to determine battery location.
|
| Ï |
Remove batteries lodged in the esophagus, nose, or ear emergently. Use
endoscopy for removal of batteries in the esophagus.
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| Ð |
Determine the battery diameter and chemical system from the imprint
code. Call 202-625-3333, the National Battery Ingestion Hotline, for assistance
and to report all cases.
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| Ñ |
Do not retrieve batteries which have passed beyond the esophagus unless
significant injury to the gastrointestinal tract is evident (based on signs and
symptoms). Avoid ipecac administration.
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| æ |
If the battery has passed beyond the esophagus and the patient has no
clinical evidence of significant injury to the gastrointestinal tract, the patient
should be managed at home, with a regular diet and normal activity to promote
gastrointestinal transit. Be alert for special circumstances involving an ingested
battery with diameter > 15 mm.
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| ç |
Confirm battery passage by inspection of stools. In asymptomatic
patients, radiographs may be repeated 7 to 14 days postingestion if battery passage
has not yet been observed.
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| è |
Mercury or other heavy metal poisoning is unlikely. Avoid
obtaining blood or urine mercury levels unless mercuric oxide cells split in the
gastrointestinal tract or radio-opaque droplets are evident in the gut. Chelation
therapy is only used in the rare instance of toxic mercury levels or when clinical
manifestations of mercury poisoning become evident. Legislation enacted in 1996 bans
the marketing of mercuric oxide button cells in the U.S.
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Battery in the Nose or Ear?
Button batteries may also cause severe injury when placed in the nose or in the ear.
Young children and the elderly have been particularly involved in this kind of incident.
Immediate removal is essential to prevent severe damage. Whenever pain and/or a discharge
is noted from the nose or ears, an exam should be conducted to exclude the presence of a
foreign body. NEVER use nose or ear drops until the person has been examined by a
physician as these fluids cause additional injury if a battery is involved.
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