01-25-18 What are the dangers of button batteries?

                        Toxicology Question of the Week

January 24, 2018

What are the dangers of button batteries?

Button batteries are small, shiny, and resemble candy which makes them very attractive to children. These tiny batteries can fit into a child’s nose and ears and can easily be swallowed. Larger diameter button batteries such as the 20 mm lithium coin cell batteries are about the size of a nickel. These batteries are becoming more popular because they last longer and have a slim shape that fits easily into compartments. Uncharged or “dead” batteries still have the potential to create enough electrical charge to cause harm.

Button batteries cause damage to tissues by generating an external electrolytic current that hydrolyzes tissue fluids and produces hydroxide at the negative pole. Due to the narrow diameter of a small child’s throat, an ingested button battery can become lodged and burn a hole in the esophagus in two to four hours. If this occurs, severe bleeding, injury requiring surgical repair, or death can occur. Other complications include vocal cord paralysis and months of feeding tubes and endotracheal tubes. When placed in the ear, damage to the ear canal and tympanic membrane can occur, and can result in hearing loss and facial nerve paralysis. Placement in the nose can cause nasal mucosal injury and septal perforation. Unwitnessed lodging of button batteries in any location results in delayed diagnosis and carries the greatest potential for greater injury.

            When button batteries are swallowed and lodged in the esophagus, a child may not experience any immediate symptoms. This can make it difficult to assess whether a child may have ingested a battery and delays treatment. Once the battery starts to burn the esophagus, symptoms can manifest as common illnesses such as fever, coughing, wheezing, vomiting, drooling, and loss of appetite. Chest pain can also occur when a button battery is swallowed which can be indicative of it being lodged in the esophagus.

Tennessee Poison Center recommends X-ray imaging as soon as possible. Timing is crucial and should not wait until symptoms occur. The x-ray distinguishes a button battery from a coin, as the battery appears to have a halo shape as opposed to a solid circle.  The x-ray also determines the location of battery.  If the battery is in the esophagus, endoscopic removal is necessary. If the button battery is in the stomach or intestines, it will pass without intervention.

For further question or concerns about button batteries, call and speak with a specialist at the Tennessee Poison Center 1-800-222-1222 or the National Battery Ingestion Hotline at 1-800-498-8666.

Resources:      

Button Battery Injuries in Children: A Growing Risk. Healthychildren.org. https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Button-Batteries-Damaging-if-Swallowed-Put-in-Ears-or-Nose.aspx. Updated February 2, 2017. Accessed November 27, 2017.

More information for patients can be found here: Poison Control - National Capital Poison Center: https://www.poison.org/articles/button-batteries

This Question was prepared by Lindsey Parks, PharmD Candidate of 2019, Lipscomb University College of Pharmacy and Nena Bowman, PharmD, DABAT, Managing Director of the Tennessee Poison Center

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu

Donna Seger, MD

Medical Director

Tennessee Poison Center

www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222

The Question of the Week is available on our website: www.tnpoisoncenter.org