Button/coin cells are batteries specially designed for a wide variety of small appliances such as hearing aids, watches and toys. These batteries have the shape of a button/coin, hence their name, and come in different sizes.
- Ingestion of coin cell batteries is often misdiagnosed for a variety of reasons,
- Ingestion of batteries, particularly by young children, is not always witnessed.
- Battery ingestion has non-specific symptoms and symptoms of lithium coin cell
ingestion can resemble flu-like symptoms.
- Ingested button cells can be mistaken for coins.
- Ingested button cells can be very dangerous when they stay lodged in the esophagus which requires urgent medical attention. The risk is particularly high for lithium-containing button cells due to their higher voltage. The greater diameter adds to the hazard, as the larger diameter cell is more likely to get stuck in the esophagus.
- If the treating physician is not sure what type of battery has been ingested, treatment should be based on the assumption that a lithium battery has been ingested.
- If battery ingestion is suspected, the following guidance can be followed:
- Patients should not be given any food or fluids until an X-ray has confirmed the ingested battery is not lodged in the esophagus
- If the patient is asymptomatic, take up to 5 minutes to determine the identification number on the packaging or a matching battery (if this information is available).
- Take an immediate X-ray for all children up to 12 years old who have ingested a button cell battery, regardless of size. For children older than 12 years, an X-ray is recommended if the ingested button cell is larger than 12mm in diameter, or if symptoms are present, if more than one battery was ingested, if a magnet was coingested or if there is pre-existing esophageal disease.
- Do not wait for symptoms to develop. Lithium button cells in the esophagus may cause serious burns in just 2 hours. Patients may be asymptomatic initially, or may have vomiting, cough, decreased appetite, drooling, stridor, dysphagia, fever or hematemesis.
- Batteries in the esophagus must be removed immediately. Endoscopic removal is preferred as direct visualisation of the esophagus determines subsequent treatment.
- Expect that esophageal perforations and fistulas into the trachea or any major vessels could be delayed up to 28 days after battery removal. Monitor on a very frequent basis for these complications. Anticipate delayed respiratory compromise and vocal cord paralysis for batteries lodged in the upper esophagus. It is important to note that esophageal strictures and spondylodiscitis may not manifest for weeks to months post ingestion.
- If button cells have passed through the esophagus and no gastrointestinal injury is evident (i.e.no symptoms are present), allow the battery to pass through the body naturally.
- Medical attention will be required if symptoms develop or a large button cell, (more than 20 mm in diameter) does not pass through the pylorus in 4 days. For all other types of battery ingestion, patients will be able to monitor their condition at home with a normal diet and regular activity, until the battery passes through their system.
- Confirm passage by stool inspection or consider repeating radiographs if passage is not documented in 10-14 days.
This guidance is based on input from specialists who have extensive experience in this field.