Battery Ingestion and Exposure: A Comprehensive Guide

Epidemiology of Battery Ingestion

Battery ingestion, particularly among pediatric populations, has become a significant public health concern in the United States. Recent studies provide a comprehensive overview of this issue, highlighting the increasing number of emergency department (ED) visits and the associated complications. Between 1999 and 2019, the United States saw a 66.7% increase in the annual ingestion of button batteries, with complications rising tenfold during this period, highlighting a growing public health concern (Zipursky & Ratnapalan, 2021).

The study "Pediatric Battery-Related Emergency Department Visits in the United States: 2010–2019" by Chandler et al. (2022) describes the epidemiology of battery-related ED visits among children under 18. Data were obtained from the National Electronic Injury Surveillance System, focusing on four primary exposure routes: ingestion, mouth exposure, ear insertion, and nasal insertion. During the study period, an estimated 70,322 battery-related ED visits occurred, corresponding to an annual rate of 9.5 per 100,000 children. The study reports that button batteries were implicated in 84.7% of cases where the battery type was described, with ingestion accounting for 90.0% of ED visits. The ED visit rate was highest among children aged ≤5 years, with a mean patient age of 3.2 years. A statistically significant increase in the ED visit rate was observed from 2010 to 2017, followed by a non-significant decrease from 2017 to 2019. These findings underscore the critical need for regulatory efforts and safer battery designs to mitigate the risks (Chandler et al., 2022).

In the study "Button Battery Ingestions in Children" by Zipursky and Ratnapalan (2021), the United States National Poison Data System reported a 66.7% increase in the annual ingestion of button batteries from 1999 to 2019, with a tenfold increase in complications. Lithium batteries and those 20 mm or larger pose the greatest risk, particularly in children younger than six. Complications from button battery ingestion can include gastrointestinal perforation, aortoesophageal fistulas, and strictures, often occurring within two hours of ingestion. The urgency of management is dictated by the location of the battery, with immediate endoscopic removal required for batteries lodged in the esophagus. Additionally, administering honey or sucralfate within 12 hours of ingestion can mitigate tissue injury while awaiting definitive management (Zipursky & Ratnapalan, 2021).

These studies collectively indicate a rising trend in battery ingestion incidents, particularly among young children. The predominant involvement of button batteries necessitates improved product safety measures, public health interventions, and heightened public awareness to prevent such incidents. Enhanced regulatory policies and safer battery designs are crucial to reduce the incidence and severity of complications associated with battery ingestion in the pediatric population.

Toxicity and Risks

AA Batteries: Moderate Toxicity Risks

AA batteries, commonly used in household devices, contain alkaline substances such as potassium hydroxide. These batteries pose moderate toxicity risks, especially when ingested, and can cause chemical burns and irritation.

Evidence:

• Chemical Burns and Irritation: Ingestion can lead to severe esophageal burns due to leakage of potassium hydroxide, occurring rapidly and causing significant morbidity (Maves, Carithers, & Birck, 1984). Fatal complications like liquefaction necrosis can occur if not treated promptly (Blatnik, Toohill, & Lehman, 1977).

Symptoms of AA Batteries Ingestion:

Common symptoms include pain, drooling, difficulty swallowing, vomiting, and abdominal pain. Severe cases can lead to tracheoesophageal fistulae and strictures (Luttrell, Bennett, & Bose, 2021).

Symptoms of AA battery ingestion

Management:

Close monitoring and timely surgical intervention are critical. Batteries lodged in the esophagus should be removed immediately to prevent severe injuries (Koşar & Gorgulu, 2021). Management of AA battery ingestion, especially in children, requires close monitoring and prompt intervention to prevent severe injuries. Here are key steps based on current research:

1. Immediate Assessment and Imaging:

   • Obtain a radiograph to confirm the presence and location of the battery (Marom et al., 2010; Litovitz, 1985).

   • If the battery content is suspected to have leaked, advanced imaging, such as CT scans, may be necessary to assess the extent of caustic injury (Luttrell et al., 2021).

2. Emergency Removal:

   • Batteries lodged in the esophagus should be removed immediately to prevent severe tissue damage. This removal is typically done via rigid esophagoscopy, with a high retrieval success rate (96%) (Rosenfeld et al., 2018).

   • In cases where the battery is located beyond the esophagus, conservative management with close monitoring may be appropriate. Intervention is required if the battery remains stationary or symptoms develop (Hammami et al., 2018).

3. Post-Removal Care:

   • After removal, monitor for signs of complications such as esophagitis or perforation. Treatment may include fasting, intravenous antibiotics, antacids, and steroids (Marom et al., 2010).

   • Follow-up imaging or endoscopy may be needed to ensure the absence of leaks or further injury (Luttrell et al., 2021).

4. Multidisciplinary Approach:

   • Implement a multidisciplinary team approach for managing severe cases, including pediatricians, gastroenterologists, surgeons, and emergency medicine specialists (Leinwand et al., 2016).

   • Develop and follow clinical algorithms to standardize care and improve outcomes (Rosenfeld et al., 2018).

5. Public and Provider Education:

   • Increase awareness among parents and healthcare providers about the risks of battery ingestion and the importance of secure battery compartments in household devices (Litovitz et al., 2010).

Prompt removal of esophageal batteries and vigilant post-operative monitoring are critical to managing AA battery ingestion effectively. A coordinated, multidisciplinary approach is essential to minimize complications and improve patient outcomes.

• Long-term Effects: Esophageal and gastrointestinal injuries can lead to long-term complications such as strictures requiring ongoing medical interventions (Singh et al., 2014).

Ingestion of AA or AAA batteries can lead to chemical burns and gastrointestinal injuries. Symptoms include pain, drooling, difficulty swallowing, and vomiting. The caustic effects of potassium hydroxide in AA and AAA batteries pose significant health risks, necessitating immediate medical attention to mitigate severe esophageal and gastrointestinal injuries. Long-term monitoring is often required to manage potential complications.

AAA Batteries: Similar to AA Batteries

Like AA batteries, AAA batteries contain alkaline substances such as potassium hydroxide. These batteries pose moderate toxicity risks, especially when ingested, and can cause chemical burns and irritation.

Evidence:

• Chemical Burns and Irritation: Ingestion can lead to severe esophageal burns due to leakage of potassium hydroxide, occurring rapidly and leading to significant morbidity (Maves, Carithers, & Birck, 1984). Corrosive injuries are similar for both AA and AAA batteries (Blatnik, Toohill, & Lehman, 1977).

• Symptoms of Ingestion: Common symptoms include pain, drooling, difficulty swallowing, vomiting, and abdominal pain (Luttrell, Bennett, & Bose, 2021).

Symptoms of AAA battery ingestion.

• Management: Immediate medical intervention is crucial when managing AAA battery ingestion. Batteries lodged in the esophagus should be removed promptly to prevent complications such as esophageal perforation (Koşar & Gorgulu, 2021).

Management Steps Based on Literature:

1. Initial Assessment:

   • Radiographic Evaluation: An X-ray should be taken to locate the battery and assess its position in the gastrointestinal tract (Koşar & Gorgulu, 2021).

   • Clinical Symptoms: Evaluate the patient for pain, drooling, difficulty swallowing, vomiting, and abdominal pain (Luttrell, Bennett, & Bose, 2021).

2. Immediate Removal:

   • Esophageal Batteries: Batteries lodged in the esophagus should be removed as soon as possible to prevent mucosal damage, ulceration, and perforation (Koşar & Gorgulu, 2021).

   • Endoscopic Retrieval: If the battery is accessible and has not yet caused significant damage, use endoscopy to safely retrieve it (Litovitz et al., 2010).

3. Monitoring and Supportive Care:

   • Post-Removal Observation: Monitor the patient for signs of complications such as perforation, infection, or ongoing symptoms even after battery removal (Koşar & Gorgulu, 2021).

   • Symptom Management: Provide supportive care to manage pain and other symptoms and administer antibiotics if there is a risk of infection (Aydin et al., 2018).

4. Long-term Follow-up:

   • Gastrointestinal Surveillance: Conduct follow-up evaluations to monitor for long-term complications such as strictures or persistent gastrointestinal symptoms (Singh et al., 2014).

   • Endoscopic Surveillance: For severe cases, regular endoscopic examinations may be necessary to assess healing and detect any late-onset complications (Aydin et al., 2018).

Prompt and effective management of AAA battery ingestion is vital to prevent serious health complications. Immediate removal, careful monitoring, and appropriate supportive care are essential in managing these cases.

• Long-term Effects: Severe burns can occur within hours, leading to persistent sequelae and necessitating ongoing medical treatment (Aydin et al., 2018).

Ingestion of AA or AAA batteries can lead to chemical burns and gastrointestinal injuries. Symptoms include pain, drooling, difficulty swallowing, and vomiting.

Due to the caustic effects of potassium hydroxide, ingestion of AAA batteries poses significant health risks. Immediate medical attention is necessary to mitigate severe esophageal and gastrointestinal injuries, and long-term monitoring is often required to manage complications.

Button Battery/Button Cell (Disk Battery): High Toxicity Risks

Button batteries, also known as disc batteries, are commonly used to power small electronic devices such as toys, watches, and hearing aids. They contain alkaline substances like potassium hydroxide or lithium. Due to their small size and high voltage, they pose significant toxicity risks, especially to children. Ingestion can lead to severe burns and tissue damage within a short time.

Chemical Burns and Tissue Damage

Button batteries lodged in the esophagus can cause electrochemical burns within hours, leading to severe esophageal injuries, perforations, and even death (Litovitz & Schmitz, 1992). Lithium button batteries are particularly dangerous due to their higher voltage, accelerating tissue damage and necrosis (Tanaka et al., 1998). Batteries larger than 15 to 20 mm in diameter are more likely to get stuck in the esophagus, causing mucosal burns due to electrical current production that generates hydroxide through electrolysis and from alkaline leakage. Similar local damage can occur if the batteries become lodged in the ear or nose.

Symptoms of button cell ingestion

Ingestion incidents are frequent and have resulted in fatalities. Symptoms include:

• Rapid onset of pain

• Drooling

• Vomiting

• Chest pain

• Difficulty swallowing

• Severe cases can result in tracheoesophageal fistulas, arterial fistulization, and massive hemorrhage (Litovitz et al., 2010).

Symptoms of button cell ingestion

Management

Batteries lodged in the esophagus must be removed immediately to prevent severe complications. Delayed removal can lead to extensive tissue necrosis and long-term sequelae (Laugel et al., 1999).

Laboratory/Monitoring and Select Management:

1. Radiographs:

   • Obtain chest and abdominal radiographs to locate the battery.

2. Routine Laboratory Tests:

   • It is generally unnecessary, but tests such as CBC, blood typing and crossmatching, and a coagulation panel may be needed for patients showing signs of bleeding.

3. Asymptomatic Patients:

   • Obtain x-rays to determine the battery's location. If it has passed the pylorus, the patient can be discharged with instructions to monitor stool for battery passage.

4. Symptomatic Patients:

   • If the battery is lodged in the esophagus, endoscopic removal is necessary. Batteries stuck in the ear or nose also require removal.

5. Aspirated Batteries:

   • It may necessitate emergency airway management or a surgical airway.

6. Severe Cases:

   • Severe gastrointestinal mucosal injuries may require hemodynamic support with IV fluids, blood products, and/or vasopressors. Tamponade techniques might be needed for significant mediastinal or gastrointestinal bleeding.

Home Management

Home management is not advised for suspected button battery ingestion. All potential button battery ingestions require immediate emergency department evaluation and radiographs to determine the battery's location.

Follow-Up

Suppose the battery has passed beyond the esophagus and does not need immediate removal. In that case, patients should be monitored for battery passage in stool and advised to return if symptoms like bloody stool, abdominal pain, vomiting, fever, or loss of appetite occur. If the battery does not pass naturally, follow-up x-rays should be taken 3-4 days post-ingestion to check its location.

Toxic Substance Leakage

Button batteries can release toxic metals like mercury, cadmium, and lead, leading to systemic toxicity. Monitoring for heavy metal poisoning is crucial in cases of battery disintegration (Rebhandl et al., 2002).

Decontamination

There is no role for gastrointestinal decontamination after button battery ingestion.

Airway Management

Aspirated batteries may require emergent airway management or a surgical airway.

Antidote and Enhanced Elimination

There is no antidote for button battery exposure. Enhanced elimination techniques are not applicable.

Differential Diagnosis

Consider ingestions of other round objects such as coins, tokens, or medallions.

Button battery ingestion poses a high risk of severe burns, tissue damage, and toxic metal exposure. Immediate medical attention and removal are crucial to prevent life-threatening complications. Continuous monitoring is essential for managing potential delayed effects and ensuring comprehensive care. Batteries over 20 mm in diameter are at a higher risk of causing obstruction, delayed passage, and serious complications.

Lithium-Ion Batteries: Severe Toxicity Risks

Lithium-ion batteries are widely used in various electronic devices due to their high energy density and reliability. However, their chemical composition, which includes lithium compounds and organic solvents, poses significant toxicity risks if ingested. Ingestion of these batteries can cause severe chemical burns, systemic toxicity, and other serious health complications.

Evidence:

• Chemical Burns and Irritation: Lithium-ion batteries can cause severe chemical burns and tissue damage if ingested, leading to perforations in the esophagus and other severe complications (Chaudhary, Shrivastava, & Thanlange, 2008).

• Systemic Toxicity: Ingestion can lead to systemic absorption of lithium, causing neurological symptoms like dizziness, confusion, and potentially life-threatening complications (Mallon, White, & Thompson, 2004). Damaged batteries can release toxic gases, including hydrofluoric acid (HF) and lithium hydroxide (LiOH), posing inhalation hazards (Park et al., 2018).

• Symptoms of Ingestion: Symptoms include severe burns, nausea, vomiting, abdominal pain, and dizziness. Long-term effects include respiratory issues and systemic toxicity due to heavy metal exposure (Peng et al., 2020).

Management Steps:

 Immediate removal and medical treatment are critical. Enhanced safety designs and proper disposal methods can mitigate risks (Maraqa et al., 2018).

1. Initial Assessment:

   • Radiographic Evaluation: Perform an X-ray to locate the battery and assess its position in the gastrointestinal tract (Litovitz et al., 2010).

   • Clinical Symptoms: Evaluate the patient for severe burns, nausea, vomiting, abdominal pain, and dizziness (Mallon, White, & Thompson, 2004).

2. Immediate Removal:

   • Esophageal Batteries: Batteries lodged in the esophagus must be removed urgently to prevent severe mucosal damage, ulceration, and perforation (Chaudhary, Shrivastava, & Thanlange, 2008).

   • Endoscopic Retrieval: Use endoscopy to safely retrieve the battery, minimizing further injury to the gastrointestinal tract (Peng et al., 2020).

3. Monitoring and Supportive Care:

   • Post-Removal Observation: Continuously monitor the patient for signs of complications such as perforation, infection, or persistent symptoms even after battery removal (Park et al., 2018).

   • Symptom Management: Provide supportive care to manage pain, nausea, and other symptoms. Administer intravenous fluids and medications as needed (Chaudhary, Shrivastava, & Thanlange, 2008).

4. Handling Systemic Toxicity:

   • Lithium Absorption: Monitor for signs of systemic lithium absorption, which can cause neurological symptoms like dizziness and confusion. Conduct blood tests to assess lithium levels and provide appropriate treatment (Mallon, White, & Thompson, 2004).

   • Inhalation Hazards: Be aware of potential inhalation hazards from toxic gases like hydrofluoric acid (HF) and lithium hydroxide (LiOH) released by damaged batteries. Ensure proper ventilation and protective measures for healthcare providers (Park et al., 2018).

5. Long-term Follow-up:

   • Gastrointestinal Surveillance: Conduct follow-up evaluations to monitor for long-term complications such as strictures or persistent gastrointestinal symptoms (Peng et al., 2020).

   • Endoscopic Surveillance: Regular examinations may be necessary for severe cases to assess healing and detect late-onset complications (Chaudhary, Shrivastava, & Thanlange, 2008).

Prompt and effective management of lithium-ion battery ingestion is vital to prevent serious health complications. Immediate removal, careful monitoring, supportive care, and handling of systemic toxicity are essential steps in managing these cases.

Lithium-ion batteries pose significant toxicity risks due to their chemical composition and potential for severe chemical burns and systemic toxicity if ingested. Immediate medical attention and preventive measures are crucial to mitigate these risks.

Nickel Lithium Batteries: High Toxicity Risks

Nickel lithium batteries, utilized in various electronic devices, contain nickel and lithium compounds. If ingested, these batteries are highly toxic, posing risks of severe chemical burns and heavy metal poisoning. Leaking batteries can also cause skin irritation and burns.

Evidence:

• Chemical Burns and Irritation: Ingestion can lead to severe chemical burns and tissue damage due to the reactive nature of lithium and nickel compounds, resulting in serious complications (Chaudhary, Shrivastava, & Thanlange, 2008).

• Heavy Metal Poisoning: Ingestion can lead to the release of nickel and lithium ions, causing systemic toxicity. Symptoms include nausea, vomiting, abdominal pain, and dizziness. Severe cases can lead to neurological symptoms and potentially life-threatening conditions (Mallon, White, & Thompson, 2004).

• Symptoms of Ingestion: Symptoms include chemical burns, heavy metal poisoning, nausea, vomiting, abdominal pain, and dizziness. Chronic exposure can lead to long-term health issues such as kidney damage and neurological disorders (Bar-Sela et al., 1992).

Management:

Immediate medical intervention is necessary for Nickel Lithium battery ingestion due to severe complications that can arise. Enhanced battery designs and proper disposal methods can help mitigate risks (Saeidnia & Abdollahi, 2013). Based on the current literature, here are the key management steps:

1.     Immediate Radiographic Assessment:

o   Obtain radiographs to determine the location of the battery (Rosenfeld et al., 2018; Marom et al., 2010).

2.     Urgent Endoscopic Removal:

o   If the battery is lodged in the esophagus, urgent endoscopic removal is necessary to prevent severe tissue damage and complications such as esophageal perforation or fistula formation (Safi et al., 2017; Marom et al., 2010).

o   Rigid esophagoscopy is preferred for its high success rate in battery retrieval (Rosenfeld et al., 2018).

3.     Post-Removal Monitoring and Treatment:

o   Post-removal, monitor the patient for signs of complications such as esophagitis or perforation. Management may include fasting, intravenous antibiotics, antacids, and steroids (Marom et al., 2010).

o   Follow-up imaging or endoscopy may be necessary to ensure no leaks or ongoing damage (Safi et al., 2017).

4.     Conservative Management for Batteries Beyond the Esophagus:

o   If the battery has passed beyond the esophagus, it may be managed conservatively with close monitoring. Intervention is required if the battery remains stationary or symptoms develop (Hui & Ng, 2023).

5.     Multidisciplinary Approach:

o   Implement a multidisciplinary team approach involving pediatricians, gastroenterologists, surgeons, and emergency medicine specialists to provide coordinated care and improve outcomes (Leinwand et al., 2016).

o   Develop and follow clinical algorithms to standardize care (Rosenfeld et al., 2018).

6.     Public and Provider Education:

o   Increase awareness among parents and healthcare providers about the risks of battery ingestion and the importance of secure battery compartments in household devices (Litovitz et al., 2010).

Nickel lithium batteries pose significant toxicity risks due to their chemical composition. If ingested, they can lead to severe chemical burns and heavy metal poisoning. Immediate medical attention and preventive measures are crucial to mitigate these risks and ensure safety.

Cordless Phone Batteries: Moderate to High Toxicity Risks

If ingested, cordless phone batteries, typically Nickel-Metal Hydride (NiMH), pose moderate to high toxicity risks. Due to the presence of nickel and other metals, these batteries can cause chemical burns and heavy metal toxicity. Leaking batteries can also cause skin irritation and burns.

Evidence:

• Chemical Burns and Irritation: Ingestion of NiMH batteries can result in severe chemical burns and tissue damage, leading to complications such as perforations and requiring prompt medical intervention (Hui & Ng, 2023).

• Heavy Metal Toxicity: NiMH batteries contain nickel, which is highly toxic if ingested, causing systemic toxicity with symptoms like nausea, vomiting, abdominal pain, and dizziness. Nickel exposure is linked to various health issues, including renal damage and carcinogenic effects (Järup, 2003).

• Symptoms of Ingestion: Symptoms include chemical burns, heavy metal toxicity, nausea, vomiting, abdominal pain, and skin irritation. Immediate medical intervention is essential (Litovitz & Schmitz, 1992).

Management:

The management of cordless phone battery ingestion in children requires prompt medical intervention due to potentially severe complications. Here are the key management steps based on the literature:

1. Immediate Radiographic Assessment:

   • Obtain radiographs to determine the battery's location (Marom et al., 2010; Rosenfeld et al., 2018).

2. Urgent Endoscopic Removal:

   • If the battery is lodged in the esophagus, urgent endoscopic removal is necessary to prevent severe tissue damage and complications such as esophageal perforation or fistula formation (Safi et al., 2017; Marom et al., 2010).

   • Rigid esophagoscopy is preferred for its high success rate in battery retrieval (Rosenfeld et al., 2018).

3. Post-Removal Monitoring and Treatment:

   • Post-removal, monitor the patient for signs of complications such as esophagitis or perforation. Management may include fasting, intravenous antibiotics, antacids, and steroids (Marom et al., 2010).

   • Follow-up imaging or endoscopy may be necessary to ensure no leaks or ongoing damage (Safi et al., 2017).

4. Conservative Management for Batteries Beyond the Esophagus:

   • If the battery has passed beyond the esophagus, it may be managed conservatively with close monitoring. Intervention is required if the battery remains stationary or symptoms develop (Păduraru et al., 2021).

5. Multidisciplinary Approach:

   • Implement a multidisciplinary team approach involving pediatricians, gastroenterologists, surgeons, and emergency medicine specialists to provide coordinated care and improve outcomes (Leinwand et al., 2016).

   • Develop and follow clinical algorithms to standardize care (Rosenfeld et al., 2018).

6. Public and Provider Education:

   • Increase awareness among parents and healthcare providers about the risks of battery ingestion and the importance of secure battery compartments in household devices (Litovitz et al., 2010).

Cordless phone batteries pose significant risks due to their chemical composition, leading to severe chemical burns and potential heavy metal poisoning if ingested. In particular, cordless phone batteries containing Nickel-Metal Hydride pose significant health risks due to their potential to cause chemical burns and heavy metal toxicity if ingested. Immediate medical intervention and preventive measures are crucial to mitigate these risks and ensure safety.

Conclusion

Batteries are essential in our modern lives, but ingestion or exposure to their contents can have serious health consequences. Understanding the specific risks associated with different battery types, recognizing ingestion symptoms, and taking the appropriate immediate action can save lives. Always keep batteries out of the reach of children and handle them with care to prevent accidental ingestion or exposure.

Importance of Poison Control: If you suspect battery ingestion, contact poison control immediately. They can provide specific guidance and support while you wait for emergency services.

Risks of Battery Leakage and Corrosion: "If contact occurs, rinse the affected area immediately with water and seek medical attention.

Risks of Chewing Batteries: Chewing batteries can cause them to leak or rupture, releasing harmful chemicals that can cause burns to the mouth, esophagus, and stomach. The battery’s contents are highly caustic and can cause serious injury, requiring immediate medical attention.

Read more:

https://medicaltoxic.com/blogs/Battery_Ingestion_and_Exposure