ISSN 2398-2969      

Battery toxicity

icanis
Contributor(s):

Nicola Bates

Kate Murphy

Synonym(s): Battery ingestion


Introduction

  • Cause: chewing or ingestion of battery or batteries.
  • Signs: gastrointestinal signs.
  • Diagnosis: history and clinical signs with black or grey discoloration of teeth; X-ray confirmation of battery in gastrointestinal tract.
  • Treatment: flushing of mouth, gastroprotectants, analgesia and endoscopic or surgical removal if required.
  • Prognosis: excellent.

Pathogenesis

Etiology

  • A battery is an electrical device comprising one or more electrochemical cells that convert stored chemical energy into electrical energy.
  • There are many types of battery:
    • AA, AAA and similar batteries are typically found in household devices (eg television remote control, clocks) and toys. They may contain acid (zinc chloride) or alkali (potassium hydroxide in alkaline manganese batteries) as a conducting medium.
    • Button batteries (watch battery, button cell) are small single cell batteries, typically 5-20 mm in diameter and 1-6 mm high. They are used to power small portable electronics devices (wrist watches, pocket calculators, hearing aids - see below). They commonly contain zinc or lithium, manganese dioxide, silver oxide, carbon monofluoride or cupric oxide.
    • Hearing aid batteries are generally zinc air batteries (a type of button battery).
    • Some hand-held electronic devices contain rechargeable batteries that are not replaceable by the consumer. These batteries are lithium-ion polymer batteries (Li-Po batteries). They are available as pouch cells (like little bags) with a polymer laminate case, which makes them lighter than conventional cylindrical cell batteries. The electrolyte (eg lithium hexafluorophosphate in an organic solvent) in these batteries is an irritant.
    • Rechargeable batteries are available in many different shapes and sizes, including button batteries, AA and AAA. Commonly used chemicals include leadacid, nickel cadmium (NiCd), nickel metal hydride (NiMH), lithium ion (Li-ion) and lithium ion polymer.
    • Car batteries comprise a plastic case containing lead plates and sulphuric acid. The risk is corrosive damage from acute exposure and lead toxicity from chronic exposure. These are not discussed further here.
  • There are several different types of injury that can occur with batteries:
    • Electrical burns are a risk with button batteries. On contact with tissues, the high electrolyte composition of tissue fluid allows the battery to generate a low voltage direct current. This liberates intracellular potassium, causing cell death and electrical burns.
    • With other batteries chemical burns may occur due to current-induced alkali production or due to leakage of contents.
    • Chemical toxicity as a result of absorption of chemical content leakage has been reported in children after ingestion of mercury button batteries but these batteries are no longer generally available. The other metals in batteries are unlikely to cause toxicity. No cases of metal toxicity from non-mercury batteries have been reported in the medical or veterinary literature.
    • Tissue damage may also occur from contact at a single site as the electrical activity of the battery causes local short circuit through the tissues, as well as a rise in pH.
    • In children esophageal impaction may results in burns and tracheosophageal fistulae. Esophageal damage has not been reported in clinical cases in dogs but has been induced experimentally.
    • In children extensive local corrosive damage has been reported from button batteries in the nose or ear but this has not been reported in dogs.

Pathophysiology

  • Local tissue irritation or burns to the gastrointestinal tract.

Timecourse

  • Discoloration of the teeth and mouth will be immediate if the battery is chewed.
  • Otherwise gastrointestinal signs may develop over the next few hours.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Litovitz T, Whitaker N, Clark L (2010) Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 125 (6), 1178-83 PubMed.
  • Samad L, Ali M, Ramzi H (1999) Button battery ingestion: Hazards of esophageal impaction. J Pediatr Surg 34 (10), 1527-1531 PubMed.
  • Tanaka J, Yamashita M, Yamashita M, Kajigaya H (1998) Esophageal electrochemical burns due to button type lithium batteries in dogs. Vet Hum Toxicol 40 (4), 193-196 PubMed.
  • Gomes C C, Sakano E, Lucchezi M C, Porto P R C (1994) Button battery as a foreign body in the nasal cavities. Special aspects. Rhinology 32 (2), 98-100 PubMed.
  • Gordon A C, Gough M H (1993) Oesophageal perforation after button battery ingestion. Ann R Coll Surg Engl 75 (5), 362-364 PubMed.
  • Litovitz T L, Schmitz B F (1992) Ingestion of cylindrical and button batteries: An analysis of 2382 cases. Pediatrics 89 (4 Part 2), 747-57 PubMed.

Other sources of information

  • Osweiler G D, Hovda L R, Brutlag A G, Lee J A (2010)Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology.Ames, Iowa: Wiley-Blackwell.

Organisation(s)

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