Button Battery Ingestions

Overview

Button battery ingestions have been a problem for decades. More recently, there has been a rise in severe and even fatal injuries as a result. This trend has paralleled an increase in the ingestions involving large-diameter (20-25mm), lithium cells. Not only has the severity of injury evolved with time, but the frequency of button battery ingestions by children has also increased. In the US, battery ingestions accounted for 0.14% of all foreign body ingestions in 1995 and 8.4% in 2015. Button batteries were the most frequently ingested batteries (85.9% of battery ingestions by children).
Button battery ingestions can be devastating due to the production of hydrogen radicals and high pH causing severe caustic injury. Animal models show esophageal injury including the lamina propria and inner muscular layer in as little as 15 minutes. Injury may be ongoing, even after removal of the button battery. Fatal hemorrhage due to aortoesophageal fistula has been reported 18 days after initial ingestion. Although evidence is limited, there is considered to be a greater risk of injury for esophageal button batteries retained greater than 2 hours.
In response to the rise in severe injuries resulting from button battery ingestions, a national Button Battery Task Force was established in the US in 2012. There is ongoing surveillance as well as a management algorithm from the National Capital Poison Center available here: https://www.poison.org/battery/guideline. Professional organizations and individual centres also have developed guidelines for suggested management. At our centre, we regularly encounter patients presenting with button battery ingestion. We are also in a unique setting, with pediatric cardiovascular surgery centralized in the province; these services are 3-hours north by transport. These factors have led to the development of a local guideline to guide the triage and management of button battery ingestions in children. This guideline will ultimately be amalgamated with a province-wide guideline currently in development.