When a battery is swallowed, it is immediately considered a life-threatening emergency requiring rapid medical intervention. Batteries contain chemicals and electrical energy that can cause severe internal damage, particularly in the delicate tissues of the esophagus. This hazard is especially pronounced in small children, who are the most frequent victims of battery ingestion, often mistaking the small, shiny discs for candy or pills. The danger lies in both the corrosive materials within the cell and the electrical current generated upon contact with the body’s moist environment.
How Battery Type Determines Danger
The risk profile depends heavily on the battery’s shape, size, and chemical composition. Button or coin batteries, especially larger lithium cells (\(\geq 20 \text{ mm}\) in diameter), pose the greatest danger because they are perfectly sized to lodge in the narrowest points of the esophagus. Once lodged, the battery generates a low-voltage electrical current by connecting its terminals with the moist tissue. This current rapidly hydrolyzes water, producing hydroxide ions that create an alkaline reaction (pH up to 13), causing an intense chemical burn known as liquefactive necrosis.
Tissue damage can begin in as little as 15 minutes, with full-thickness esophageal burns possible within two hours. This injury can continue to progress even after the battery is removed, leading to delayed complications. Larger cylindrical batteries, such as AA or AAA cells, are usually too big to lodge in the esophagus and typically pass into the stomach and through the rest of the gastrointestinal tract without issue. The primary risk from these larger batteries is physical obstruction in the bowel or, rarely, chemical injury if the casing is compromised.
Immediate Symptoms of Ingestion
Recognizing battery ingestion is challenging because immediate symptoms are often vague and can mimic common childhood illnesses. Many severe cases occur after an unwitnessed ingestion, leading to a dangerous delay in diagnosis. Any suspicion of a swallowed battery warrants immediate medical attention, even if the individual appears outwardly healthy.
If the battery is lodged in the esophagus, it can cause non-specific symptoms such as coughing, wheezing, or noisy breathing due to airway compression. The individual may also exhibit excessive drooling, refusal to eat or drink, difficulty swallowing (dysphagia), vomiting, chest discomfort, or a low-grade fever. The absence of immediate, dramatic symptoms does not mean the battery has passed safely, making rapid diagnosis through imaging mandatory.
Emergency Response and First Aid Protocols
Immediate action is necessary if battery ingestion is suspected, as time is the most important factor in determining the outcome. The first step is to call the National Poison Control Center (1-800-222-1222) or local emergency services immediately. Medical professionals at the center can provide specific guidance while you are en route to the emergency department.
If the ingestion occurred within the last 12 hours and the individual is over 12 months old, administer two teaspoons (10 mL) of honey. This dose can be repeated every 10 minutes for up to six doses while traveling to the hospital, as honey temporarily mitigates tissue damage by neutralizing the alkaline environment. Never induce vomiting, as this risks a second, more severe burn, nor should you give the person food or other liquids. If possible, bring the battery packaging or an identical companion battery to the hospital for identification.
Medical Intervention and Long-Term Outlook
Diagnosis begins with urgent imaging, typically an anteroposterior and lateral X-ray of the neck, chest, and abdomen, to pinpoint the battery’s exact location and size. A battery lodged in the esophagus requires immediate endoscopic removal, which is the definitive treatment. This procedure uses a specialized flexible tube with a camera to retrieve the battery under anesthesia, ideally within the first two hours of ingestion.
If the battery has passed into the stomach and the patient is asymptomatic, observation may be appropriate, allowing the battery to pass naturally in the stool. However, large batteries (\(\geq 20 \text{ mm}\)) or those ingested by young children may still warrant removal if they do not pass within a specified time frame. After removal from the esophagus, the burn site is often irrigated with a neutralizing solution, such as a weak acetic acid, to stop the ongoing chemical reaction.
The long-term outlook is determined by the extent of the initial tissue damage, requiring extensive follow-up care to monitor for delayed complications. These complications include the development of esophageal strictures, which are scars that narrow the food pipe and require repeated dilation procedures. The most severe, though rare, complication is the formation of an aortoesophageal fistula, where the burn erodes into the aorta, resulting in catastrophic bleeding that is often fatal.