A small, disc-shaped coin or button battery placed in the mouth presents a serious health hazard. While holding a battery in the mouth might not cause injury, accidental swallowing leads to rapid and severe internal damage. This danger is pronounced in small children, who often explore objects by placing them in their mouths. The primary threat is not physical obstruction, but a combination of an electrical current and a chemical burn that begins instantly.
How Batteries Cause Internal Damage
The most severe injuries occur when a coin or button battery, particularly the larger 20-millimeter lithium variety, becomes lodged in the esophagus. The moist esophageal tissue allows the battery to complete an electrical circuit between its positive and negative poles. This current is generated even if the battery is partially or completely discharged.
The completed circuit causes water within the mucosal tissue to undergo electrolysis, splitting the water molecules. This reaction rapidly generates highly corrosive hydroxide ions at the negative pole of the battery. The accumulation of these ions creates an intensely alkaline environment, with the local pH level soaring to 10 or higher.
This caustic environment causes a severe chemical burn known as liquefaction necrosis. Unlike a thermal burn, liquefaction necrosis causes deep, progressive tissue damage by dissolving proteins and fats in the cell walls. This destruction can penetrate the layers of the esophagus, causing visible injury within two hours of impaction. The resulting damage can lead to perforation, strictures, or erosion into major blood vessels or the trachea (the airway).
Recognizing Symptoms of Injury
Because the damage from a lodged battery is swift, recognizing subtle symptoms is important, especially if the ingestion was not witnessed. A battery stuck in the esophagus often presents with signs of obstruction and irritation. These may include excessive drooling, refusal to eat or drink, or difficulty swallowing.
Other indicators of a foreign body in the throat include coughing, gagging, or noisy breathing that may sound like croup. If the caustic burn has begun to erode the tissue, the individual may experience chest pain, vomiting, or blood in their saliva or phlegm. Since these symptoms can mimic common illnesses, a high suspicion for battery ingestion is necessary.
As the injury progresses, more severe systemic symptoms can develop. These signs include fever, abdominal pain, and very dark or bloody stool, suggesting internal bleeding. Since symptoms may be delayed or mimic a simple viral infection, any suspicion of ingestion warrants immediate medical attention.
Emergency Protocol for Ingestion
If battery ingestion is suspected, it is an urgent medical emergency requiring immediate action. The first step is to call a local emergency number or the national Poison Control Center for expert guidance. Time is a determining factor in the outcome, as serious tissue damage can begin within minutes.
Do not attempt to induce vomiting, as this can cause the battery to become lodged elsewhere or increase the risk of aspiration. Do not give the person anything to eat or drink, unless specifically instructed by Poison Control or a medical professional. Honey or a medication like sucralfate may be recommended as an en route mitigation measure for children over 12 months, but this must be specifically advised while traveling to the hospital.
The individual must be taken to an emergency department immediately, ideally one with pediatric surgical capabilities. If the type of battery is known, bring the packaging or a matching battery, as this information guides treatment. Swift removal of the battery, often through an endoscopic procedure, is the only way to halt the progressive caustic burn and prevent life-threatening complications.