Button Battery: To intervene or not

According to an article published by the American Academy of Pediatrics in 2010, severe and fatal battery ingestions are increasing, and many patients are being treated inadequately for button battery ingestions. From 1985 to 1009, there has been a 6-fold increase in button battery ingestions with resulting major or fatal outcomes. The largest increase has been with lithium-cell batteries (24% of ingestions) and 20-25mm diameter batteries (18% of ingestions). 20mm lithium cells are the most common to be associated with severe outcomes.

A high index of suspicion is needed; 54% of fatal outcomes are misdiagnosed, usually complicated by nonspecific presentations. Most serious battery ingestions are not witnessed. Consider an ingestion anytime a patient is wheezing, drooling, vomiting, or has chest pain or discomfort.

Evaluating a battery ingestion

Keep the patient NPO until an esophageal foreign body is ruled out with imaging.

• Try to determine the imprint code on a companion or replacement battery or packaging. If you are not able to, attempt to measure the space the battery fit into, or the size of the battery on the X-ray.
  
• Call the National Battery Ingestion Hotline at 202-625-3333
  
• If the patient is less than 12 years-old, immediately get an x-ray to locate the battery. Batteries in the esophagus can cause severe burns in as little as 2 hours.
  
• Any patient who has a battery retrieved from the esophagus should be admitted for observation.
  
• If the patient is >12 years old, and the battery diameter is >12mm or unknown, obtain X-ray
  
• If the patient is > 12 years old and the battery is <12mm, the patient is asymptomatic, the patient has only ingested one battery, and no co-ingested magnets, then no imaging is needed if the patient has good follow up.
  

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