National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline
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
Button Battery Awareness 