From the Guidelines
The treatment for ingested button batteries requires immediate emergency medical attention, with emergent flexible endoscopy recommended within 2 hours, at latest within 6 hours, to remove the battery and prevent severe chemical burns and tissue necrosis 1. When a button battery is swallowed, it is essential to act quickly to minimize the risk of complications.
- Give honey (10mL/2 teaspoons) every 10 minutes for children over 12 months of age while en route to the emergency department, for up to 6 doses, to help coat the battery and reduce tissue damage.
- For adults, use 2 tablespoons of honey.
- Do not induce vomiting or give food or drink other than honey. Upon arrival at the hospital, healthcare providers will:
- Locate the battery using X-rays
- Remove it endoscopically if it's in the esophagus, as recommended by the World Journal of Emergency Surgery guidelines 1 Batteries in the stomach may pass naturally if the patient is asymptomatic, though this requires monitoring. Button batteries are dangerous because they can create an electrical current when in contact with tissue, producing hydroxide ions that cause severe chemical burns, tissue necrosis, and potential perforation within 2 hours 1. The damage continues even after the battery is removed, so follow-up care and monitoring for complications like strictures or fistulas is essential, as highlighted in the esophageal emergencies guidelines 1.
From the Research
Treatment for Ingested Button Batteries
- Immediate localization of the button battery is crucial, and in case of esophageal impaction, the battery should be removed instantly (preferably <2 hours) 2
- Honey and sucralfate can be considered in ingestions ≤12 hours while waiting for endoscopic removal, but should not delay it 2
- In case of delayed diagnosis (first confirmation of the button battery on X-ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction, a CT scan should be performed to evaluate for vascular injury before removing the battery 2
- In asymptomatic patients with early diagnosis (≤12 hours after ingestion) and position of the button battery beyond the esophagus, monitoring with repeat X-ray (if not already evacuated in stool) in 7 to 14 days can be considered 2
Importance of Prompt Medical Attention
- Button battery ingestions can lead to severe esophageal injuries, including burns, perforation, and stenosis, even after a few hours 3, 4
- Prompt endoscopy is necessary to prevent further damage, especially in cases where the battery is lodged in the esophagus 3, 4
- Patients who have ingested a button battery should be directed to the emergency department for medical evaluation, even if the battery has been expelled from the body, especially if gastrointestinal symptoms are present 5
Prevention and Education
- Education plans for health personnel and the general population regarding the dangers of button batteries and the urgency of attention once an ingestion has occurred are essential 6
- Establishing protocols in each institution for appropriate and urgent extraction of ingested button batteries can help prevent complications and improve outcomes 6