July 03, 2012

Lithium Disc Battery Danger for Kids (and Hot Dogs)

In the last 10 years, 13 deaths related to swallowed batteries have been reported, 12 of which were due to disc batteries (20 millimeter lithium cells).

The danger is that when a disc battery is inserted into a nose (for example), a localized electric current is created between the positive and negative poles of the battery within the nose. This electric current basically "electrocutes" the lining inside the nose leading to tissue damage and ultimately necrosis (tissue death) within an hour. The same applies even if the battery is swallowed or put into the ear canal.

When swallowed, it can burn through the esophageal/intestinal lining causing a perforation which can lead to death if not promptly treated (or even in spite of it if too much time passes before treatment).

Treatment is IMMEDIATE removal... as soon as possible. Regardless of the day or time. 

For illustrative purposes, lets see what happens to a hot dog when a lithium disc battery is placed inside it. This example was created by Dr. Stephen Marcus who is the director of the New Jersey Poison Information Center and published in the Pediatrics Blog here. You can also do this at home... give it a try (make a slit in the hot dog and push a lithium button battery into it... than watch).

Just 3 hours later, this is what you would see...

Keep disc batteries away from kids!!!

That said, a study performed to determine the average time to esophageal perforation showed that only 2% of perforations occurred within 24 hours after ingestion. Another 7.4% of perforations became evident 24 to 47 hours after ingestion, and 10.1% of perforations became evident 48 to 71 hours after ingestion. Perforations were evident by 3 days after ingestion in 26.8%, by 4 days in 36.9%, by 5 days in 46.3%, and by 9 days in 66.4%. It is important to note that this does not mean that removal can be delayed, because the period of peak electrolysis activity and battery damage occurs within the first 12 hours. Rather, this result means that adjunctive measures, such as administration of honey or sucralfate, can be safely taken and will likely benefit the patient because they may be able to coat the battery and prevent local hydroxide generation.

A lithium battery in a hot dog is no picnic. Pediatrics Blog 7/2/2012

Pediatric Battery-Related Emergency Department Visits in the United States, 1990–2009. PEDIATRICS Vol. 129 No. 6 June 1, 2012 pp. 1111-1117

Preventing Battery Ingestions: An Analysis of 8648 Cases Published online May 24, 2010 PEDIATRICS (doi:10.1542/peds.2009-3038)

A Review of Esophageal Disc Battery Ingestions and a Protocol for Management Arch Otolaryngol Head Neck Surg. 2010;136(9):866-871. doi:10.1001/archoto.2010.146

Time to perforation for button batteries lodged in the esophagus. The American Journal of Emergency Medicine. Volume 37, Issue 5, May 2019, Pages 805-809
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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