Management overview for button battery ingestion

Button battery exposure is an increasing global problem due to widespread use of button batteries in common household objects, such as remote control devices, car keys, glucometers, LED candles, torches, and flashing, talking and musical toys.

Following ingestion, most button batteries pass through the gastrointestinal tract uneventfully, but if they become lodged in the oesophagus or airway, they can cause significant burns due to the battery’s electrical discharge. While significant burns can occur less than 2 hours after ingestion, injury can continue for many hours while the battery is discharging and even after removal of the battery. Injury from button battery ingestion can lead to viscus perforation, aorto-oesophageal fistula, catastrophic haemorrhage and death.

Young children are at high risk of button battery ingestion because they frequently put objects in their mouth. A very high index of suspicion of button battery ingestion is required in young children because early symptoms of button battery ingestion are often nonspecific (eg pain, nausea, vomiting, loss of appetite), young children cannot provide a reliable history, and these exposures are rarely witnessed.

If button battery ingestion is suspected, particularly if the patient is in a remote location, urgently consult a clinical toxicologist or poisons information centre (13 11 26).

In any patient who presents with a suspected button battery ingestion, particularly children younger than 5 years, immediately perform an X-ray of the neck, chest and abdomen. If a button battery is seen in the oesophagus or airway on X-ray, urgently refer the patient for endoscopic removal of the battery. Button battery removal is time critical and immediate removal is required even in delayed presentations.

Insertion of button batteries into other orifices (ear, nose, vagina, rectum) can also cause burns, but are less time critical than those in the oesophagus or airway.