Button Battery Ingestion

Aka: Button Battery Ingestion, Button Battery

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II. Types

  1. Disc batteries (especially Lithium batteries)

III. Epidemiology

  1. Most common in toddlers
  2. Screen adolescents Button Battery Ingestions for Suicidality

IV. Precautions

  1. Button batteries leak alkaline agents and cause liquifaction necrosis when in contact with tissue
    1. Via hydroxide free radicals within the esophageal mucosa
  2. Risk of voltage burn or corrosive injury
    1. Serious esophageal burns occur within 2 hours (even within 30 min)
      1. High risk of Esophageal Perforation in first 6 hours
    2. Tomaszewski (2016) Household Toxins Lecture, ACEP PEM Conference, attended 3/8/2016

V. Symptoms

  1. Symptomatic in two thirds of children

VI. Imaging

  1. XRay
    1. Appears as double ring similar to 2 stacked coins (stack sign) or poker chip on XRay
  2. MRI
    1. May be used after Button Battery removal to assess tissue injury progression

VII. Management: Ingested Button Battery

  1. Adjunctive management (given within first 12 hours of ingestion)
    1. Sucralfate
      1. Give 1 g every 10 minutes for 3 doses while awaiting upper endoscopy
    2. Honey (in age >1 year)
      1. Give 10 ml every 10 minutes for 6 doses while awaiting upper endoscopy
      2. Mechanism: May neutralize pH and reduce mucosal injury
    3. References
      1. Soto (2018) Am J Emerg Med 37(5):805-809 +PMID:30054113 [PubMed]
  2. Button Battery in Esophagus
    1. Requires emergent upper endoscopy for removal (typically gastroenterology)
      1. Remove within 2 hours of ingestion
      2. Initiate early, emergent transfer if endoscopy not available at facility
    2. Exception
      1. Healthy, asymptomatic child >12 years old AND
      2. Single battery <12 mm in size without magnet
  3. Button Battery distal to Esophagus
    1. Symptomatic Button Battery or magnet coningestion
      1. Remove Button Battery with emergent upper endoscopy
      2. Also consider emergent upper endoscopy in high risk asymptomatic patients
        1. Age <6 years
        2. Multiple batteries
        3. Diameter >14 mm
        4. Battery and magnet coingestion
    2. Asymptomatic button batteries below the Esophagus (e.g. Stomach)
      1. May attempt removal with endoscopy if in Stomach
      2. May be followed with serial XRay
      3. Expect to pass through pylorus within 48 hours and out with stool by 72 hours (up to 10-14 days)
      4. Large battery >20 mm
        1. Allow 48 hours to pass if asymptomatic (4 days if age < 6 years)
      5. Coingested battery and magnet
        1. High risk of magnet entrapping battery against mucosa, resulting in intestinal perforation risk
        2. Remove regardless of location (distal to Esophagus, Stomach)

VIII. Management: Other Button Battery foreign body involvement

  1. See Ear Foreign Body
  2. See Nasal Foreign Body
  3. Remove Button Battery as soon as possible
  4. Do not get the battery wet (moisture increases alkaline leakage and tissue damage)
  5. Use blunt object for removal (do not use a sharp instrument)

IX. Complications

  1. Vascular fistula formation (high risk for death by Exsanguination)
    1. Aortoesophageal fistula
    2. Aortoenteric Fistula
  2. Esophageal Perforation
    1. Mediastinitis
  3. Esophageal Stricture
  4. Pneumothorax
  5. Pneumomediastinum

X. Prognosis

  1. Children die from unrecognized Button Battery Ingestions (esp. unwitnessed in age under 3 years)
    1. Lithium battery >20 mm diameter ingestion is associated with 13% mortality in children

XI. Resources

  1. National Poison Control Center Protocol
    1. https://www.poison.org/battery/guideline

XII. References

  1. Claudius in Herbert (2017) EM:Rap 17(11):3-5
  2. Litovitz (2010) Pediatrics 125(6): 1178-83 +PMID:20498172 [PubMed]
  3. Valerio (2026) Am Fam Physician 113(4): 326-31 [PubMed]

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