HWN Suggests

Hide And Seek: Button Batteries in the Emergency Department

For ingestions, plain radiographs can reveal a radio-opaque foreign body with a “double shoulder” appearance which is not seen in coin ingestion and should raise suspicion that the foreign body is a button battery.

Further management depends on the location of the battery and there are several pathways available online to guide this process; generally, if the battery is beyond the oesophagus the asymptomatic child can be observed at home with careful safety netting and potentially regular review to ensure the battery passes. Do NOT induce vomiting – this can cause retrograde movement of the battery from the stomach into the oesophagus. Co-ingestion of a magnet also necessitates removal,…

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 Button Battery Update

What makes button battery ingestion more frightening is the fact that the ingestion may go unwitnessed, the child may have vague symptoms like ‘off food’ and later haematemasis can result from erosion of the battery through the oesophagus and into the thoracic aorta.

 Cute as a Button? – Toxicology Blog

The most important aspect of management is time. In less than one-minute, electric discharge from a button battery can raise the pH of the surrounding tissue to 11. Studies have shown that visible injury is noted in 15 minutes, and significant damage and perforation can occur in as little as 2 hours. Therefore, button battery ingestion should be on the differential, especially in the pediatric patient, to quickly identify this “can’t miss” diagnosis.

 TOXCard: Button Battery Ingestions

Batteries beyond the esophagus will pass usually without complications.

Articles of Interest

Button Battery Ingestion

Button batteries are one of these unique objects that warrant our specific concern and respect!

A Truly Emergent Problem: Button Battery in the Nose

Since the advent of the button battery, there is now urgency in identification and removal of this variant of nasal foreign body.

Button Battery Ingestion Protocol

While not a common occurrence, button battery ingestions can be catastrophic, leading to esophageal injury within two hours post ingestion, and should be considered a surgical emergency.

Button Battery Ingestion: A Case Report

Battery injuries caused to human tissue by button batteries were originally thought to be due to an exothermic reaction resulting in thermal tissue injury. Jatana and colleagues (2017) realized damage from ingested button batteries was due to a caustic alkaline reaction primarily at the negative pole of the battery. Batteries resulting in the most rapid and severe injuries were noted to be 3V lithium batteries.

Clinical Evaluation of Disc Battery Ingestion in Children

Most cases of disc battery ingestion run uneventful courses, but some may be complicated. If the battery lodges in the esophagus, emergency endoscopic management is necessary. However, once in the stomach, it will usually pass through the GI tract.

Current management of button battery injuries

Patients who are asymptomatic, >12 years of age with known isolated BB ingestion of ≤12 mm diameter, have no preexisting esophageal disease and have a reliable caregiver can be observed at home with regular diet and encouraged activity, with consideration of XR if BB passage has not been confirmed by stool inspection in 10 to 14 days.

Lithium Disc Battery Danger for Kids (and Hot Dogs)

The danger is that when a disc battery is inserted into a nose (for example), a localized electric current is created between the positive and negative poles of the battery within the nose. This electric current basically "electrocutes" the lining inside the nose leading to tissue damage and ultimately necrosis (tissue death) within an hour. The same applies even if the battery is swallowed or put into the ear canal.

Resources

National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline

Most serious battery ingestions are not witnessed. Consider the possibility of a battery ingestion in every patient with acute airway obstruction; wheezing or other noisy breathing; drooling; vomiting; chest pain or discomfort; abdominal pain; difficulty swallowing; decreased appetite or refusal to eat; or coughing, choking or gagging with eating or drinking. Suspect a button battery ingestion in every presumed "coin" or other foreign body ingestion.

NUEM Blog

Batteries, if located in the stomach, can be observed for passage if the patient is asymptomatic. The patient should be closely observed for battery passage and can be followed with serial x-rays to ensure passage

RebelEM

Consider button battery ingestion in children presenting with dysphagia, refusal to eat and hematemesis.

StatPearls

The current national guidelines (NBIH and Button Battery Taskforce) support observation and serial radiographs in 10-14 days. For higher-risk patients (less than age six or with button batteries 15 mm or greater), repeat films should be obtained in 4 days, with endoscopic removal for batteries that have not passed through the stomach.