The January Nuts & Bolts discussed the hazards of ingesting a hearing aid battery. Soon thereafter we received a letter (see below) from Toby Litovitz, MD, head of the National Capital Poison Center, advising us to add urgency to the warning that concluded our column: “The best advice is 'Go to your doctor—immediately! Better yet, go to the ER.'”
As the father of Nut & Bolts and usually its author, I'm always looking for experts who can help me write about interesting topics. Last year I met and became friends with Errol Korn, MD, a gastroenterologist. When I heard he had removed a hearing aid battery from a patient's GI tract, I asked him to write about ingestion of hearing aid batteries for us. He kindly agreed. Dr.Korn once told me, “An ingested battery could burn a hole in you.” I thought he was exaggerating, but now I know he was not!
In the last few days I have learned a lot about battery ingestion. Please note that ingestion of any battery, including a hearing aid battery, is dangerous, and the newest lithium cells are especially harmful.
Dr. Litovitz provided me with plenty of information. She told me of several documented cases in which an ingested battery “burned” a hole first through the esophagus and then the aorta, causing patients to bleed to death. Here are some other important facts from the National Capital Poison Center:
* More than 3000 cases of button battery ingestion are reported to U.S. poison control centers each year.
* About eight cases a year result in serious problems, such as severe damage to the esophagus.
* Children have died after battery ingestion.
* The problem is getting worse.
WHY INGESTION IS SO DANGEROUS
The electrical capabilities of a typical hearing aid battery are not high enough to cause it to get physically hot when the battery shorts out. But the problem when a battery is swallowed is not heat. And, while damage may be caused by alkaline material in the battery leaking out, the primary danger comes from the electrical current causing a “chemical burn” to body tissues when the battery becomes lodged.
The most dangerous situation is when a larger lithium cell battery (20-mm diameter) gets stuck in the esophagus. The battery pressing against the esophageal tissue and the residual current in the battery can generate very destructive reactions in the esophagus. Hydroxide is formed and an alkaline burn develops.
When a young child swallows a battery, parents are often unaware of it. The child may cough, vomit, refuse to eat, or show other symptoms without the problem being discovered. Without a history of ingestion, a physician is likely to diagnose a flu-like or viral illness. The battery lodged in the esophagus may go undetected. This is a dangerous situation.
WHAT SHOULD YOU DO?
If you hear of a patient—or anyone else—swallowing a battery, tell them to call the 24/7 National Battery Ingestion Hotline at 202/625-3333 and follow their advice.
Readers should be aware of the dangers of battery ingestion and how to respond, not simply as professionals, but also as parents, grandparents, and caring members of the community.
THERE'S NO TIME TO WASTE
I read the recent article by Errol Korn in Nuts & Bolts. I was pleased to see you informing your readers of some of the risks associated with hearing aid batteries, but your advice failed to convey a sense of urgency.
“Go to your doctor” implies waiting until you can be scheduled. Although hearing aid batteries aren't the riskiest of ingested batteries, larger button cells (such as the popular lithium coin cells found in so many electronic devices) can cause life-threatening damage in just 2 hours. Burns to the esophagus may lead to perforations, massive exsanguination, connections (fistulas) into the trachea, and months to years of impaired feeding, requiring many surgeries and procedures.
Please advise your readers that they should call the 24/7 National Battery Ingestion Hotline (202/625-3333) for treatment guidance as soon as they suspect that a button cell has been ingested. An immediate emergency room visit will usually be necessary as an x-ray should be done right away to be sure the battery is not lodged in the esophagus.
Of course, the most successful strategy for managing battery ingestions is to prevent them. Readers who missed Dr. Korn's article should check out his “common sense suggestions.” They are right on the mark!
Toby Litovitz, MD
Executive & Medical Director
National Capital Poison Center