Information for Medical Providers

National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline

National Capital Poison Center

Keep it in your differential

Most serious battery ingestions are not witnessed by a parent or guardian.

If button batteries are in the home, there is a possibility of ingestion.

Suspect a button battery ingestion in every presumed “coin” or other foreign body ingestion.

Get an x-ray and look for the “halo- sign” and/or “step-off sign”

Signs and Symptoms

  • Airway obstruction or wheezing
  • Drooling
  • Vomiting
  • Chest discomfort
  • Difficulty swallowing, decreased appetite, refusal to eat
  • Coughing, choking, or gagging with eating and drinking
  • Unexplained nosebleed

Clinical Pearls

  • “3 Ns” – Negative, Narrow, Necrotic
    • The negative battery pole, identified as the narrowest side on the lateral x-ray, causes the most severe, necrotic injury.
  • 20 mm lithium button battery are most frequently involved in esophageal injuries.
  • Smaller button batteries (like hearing aid batteries) can still get lodged and cause injury or death. These also pose a risk for ears and noses.
  • Do NOT induce vomiting. Pt is NPO except honey or sucralfate suspension.
  • X-ray the abdomen, esophagus, and neck. If the battery is in the esophagus, obtain an AP and Lateral view to determine negative pole.

If you do treat a button battery injury be sure to report the case at Global Injury Research Collaborative