What is the greatest concern for a 2-year-old girl who swallowed a nickel-cadmium battery?

Management of Nickel-Cadmium Battery Ingestion in a 2-Year-Old Child

The greatest concern for a 2-year-old girl who swallowed a nickel-cadmium battery is gastrointestinal ulceration, which can occur rapidly and lead to serious complications even when the battery has apparently passed through the digestive tract. 1

Assessment of Current Situation

The patient appears to be clinically stable:

• Battery was swallowed yesterday afternoon
• Normal stool was present this morning with no sign of battery
• Child is in no distress, comfortable and playful

However, this clinical picture can be deceptive in battery ingestion cases:

Key Concerns with Battery Ingestion

1. Chemical Burns: Batteries can cause severe tissue damage through:

   • Electrochemical burns when in contact with digestive mucosa
   • Release of caustic substances if the battery casing is compromised 2

2. Timeframe for Injury: Severe burns with sequelae can occur in just 2-2.5 hours of contact with tissue 3

3. Delayed Complications: Even after apparent passage, complications may include:

   • Delayed esophageal perforations
   • Fistula formation
   • Massive hemorrhage 3

Management Algorithm

1. Immediate Imaging

Despite the apparent passage in stool, confirmation is essential:

• Obtain plain radiographs (X-rays) of the abdomen to confirm complete passage 1
• Look for any retained battery fragments or multiple batteries

2. Clinical Evaluation

• Assess for any signs of abdominal pain, vomiting, or gastrointestinal bleeding
• Even asymptomatic patients may have significant mucosal damage 4

3. Follow-up Care

• If X-ray confirms complete passage and child remains asymptomatic, close observation at home with clear return precautions
• If any fragments remain or symptoms develop, urgent endoscopic evaluation is warranted 1
• Monitor for delayed complications for at least 2-4 weeks after ingestion

Special Considerations for Nickel-Cadmium Batteries

Nickel-cadmium batteries pose specific risks:

• Cadmium Toxicity: Cadmium is a toxic heavy metal that can cause systemic effects if absorbed 5
• Battery Size: The battery was described as between the size of a quarter and nickel, making it large enough to potentially cause significant damage

Common Pitfalls to Avoid

1. Assuming safety after apparent passage: Even after a battery appears to have passed, mucosal damage may have occurred and complications can develop days later 3

2. Relying solely on clinical appearance: Many children with significant battery-induced injuries initially appear well 3

3. Delaying intervention: The 2010 study by Emerging Battery-Ingestion Hazard showed that 27% of major outcome cases were initially misdiagnosed due to nonspecific presentations 3

4. Overlooking heavy metal toxicity: While immediate corrosive injury is the primary concern, cadmium exposure should be monitored, especially if the battery casing was compromised 5

While this child appears to have passed the battery without immediate complications, vigilant follow-up is essential to identify any delayed manifestations of gastrointestinal injury, which represents the greatest concern in this clinical scenario.