Toxicology – Button Battery Ingestion

Sources

Button or coin batteries are commonly found in:

• Toys
• Watches
• Hearing aids
• Remote controls
• Small electronic devices

Young children are at greatest risk because the batteries are small, shiny, and easy to swallow.

Typical Presentation

A toddler may swallow a button battery and initially appear completely well.

The most dangerous situation is when the battery becomes lodged in the esophagus.

Clinical Features

Symptoms may include:

• Drooling
• Coughing
• Vomiting
• Dysphagia
• Chest discomfort
• Refusal to eat

However, some children with an esophageal battery may initially have few or no symptoms.

Serious complications include:

• Deep esophageal burns
• Perforation
• Tracheoesophageal fistula
• Injury to major blood vessels
• Mediastinitis

Batteries lodged in the nose or ear can also cause rapid local tissue injury.

Mechanism of Action

The main injury is caused by an electrical current that generates hydroxide ions at the battery surface.

This creates a strongly alkaline environment and causes liquefactive necrosis.

Severe tissue injury can begin within only a few hours.

Diagnosis

Plain radiographs are used to determine:

• Whether a battery is present
• Its location
• Whether it is still in the esophagus

Button batteries can usually be distinguished radiographically from coins by their characteristic layered appearance.

Management

An esophageal button battery is an emergency and requires prompt endoscopic removal.

Important principles include:

• Rapid localization with imaging
• Immediate specialty consultation
• Urgent removal if lodged in the esophagus
• Monitoring for delayed complications after significant esophageal injury

Batteries that have already passed into the stomach or intestine often pass spontaneously, but management depends on factors such as symptoms, battery size, age, location, and evidence of GI injury.

Key Points

• Esophageal impaction is the major emergency.
• Serious tissue injury can occur rapidly, sometimes within about 2 hours.
• A child may appear well despite significant internal injury.
• Large lithium coin cells are especially concerning.
• Batteries beyond the esophagus are often managed expectantly if the patient is asymptomatic and the battery continues to progress.
• Button batteries in the ear or nose also require prompt removal because they can cause rapid liquefactive tissue damage.