Advice for medical sector on making the right
diagnosis and offering the right treatment
How to make the right diagnosis?
The ingestion of button batteries/coin cells can be misdiagnosed for a variety of reasons, including:
- The ingestion, 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 batteries/coin cells can be mistaken for coins.
Ingested button batteries can be very dangerous when they stay lodged in the esophagus and require urgent medical attention. The risk is particularly high for lithium-containing coin 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, the treatment should be based on the worst case scenario assumption that a lithium coin cell battery has been ingested.
If battery ingestion is suspected, we recommend the following:
- 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 coin cells in the esophagus can 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.
- Button 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 button 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 batteries have passed through the esophagus and no gastrointestinal injury is evident (i.e.no symptoms are present), allow the button battery to pass through the body naturally.
- Medical attention will be required if symptoms develop or if large button batteries or coin cells (more than 20 mm in diameter) do not pass through the pylorus in 4 days. For all other types of button battery ingestion, patients will be able to monitor their condition at home with a normal diet and regular activity, until the button 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.