Lithium Button Battery Research Articles

Association between the corrosion of ingested lithium button battery in the esophagus and its complications in pediatric patients.

The incidence of lithium button battery ingestion has been increasing recently, which results in severe complications. We aimed to demonstrate the association between the corrosion of lithium button batteries in the esophagus on radiographs and their complications. The nine pediatric patients included in this study were classified into two groups based on the presence of severe complications. The presence and degree of corrosion on plain radiographs were evaluated. The degree of corrosion was classified into the following three grades; none: 0%; moderate: 1-50%; severe: 51-100%. Fisher's exact test was used for statistical analyses. Of the nine patients, five showed complications. The number of patients who had grade none, moderate, and severe degrees of corrosion was three, four, and two, respectively. The incidence of severe complications differed significantly between the incidence of lithium button batteries' contour (without vs. with severe complications [presence/absence of corrosion] = 1/3 vs. 5/0, respectively; P = 0.0476). In cases with "none" degree of corrosion, all three cases had no complication, and in cases with a "severe" degree of corrosion, all two cases had complications. The cases with the presence of corrosion of lithium button batteries had a higher tendency to have severe complications. Therefore, physicians should anticipate the presence of severe complications in pediatric patients with corrosion more than those without corrosion.

Magnetic resonance imaging findings following button battery ingestion.

Lithium button battery ingestions have been increasing in frequency since the early 2000s and can develop severe and sometimes fatal complications from caustic injury even after rapid battery removal. To aid in clinical decision-making, we began obtaining magnetic resonance imaging (MRI)/MR angiography in these patients. Our goal was to review MRI/MR angiography imaging in button battery ingestion cases and compare with other imaging, clinical data and outcomes in these patients. In this retrospective institutional-review-board-approved study, we reviewed all button battery ingestion cases with MRI from April 2012 to September 2018. Clinical data, endoscopic findings and all imaging studies were rereviewed. MRIs were evaluated for inflammation, blooming artifact and complications including vascular injury, tracheoesophageal fistula, esophageal perforation and spondylodiscitis, and compared to endoscopy, esophagram and bronchoscopy. Twenty-three patients with button battery ingestions had a total of 51 MRI/MR angiograms. Seventy percent of the cohort was male with a median age of 2years (range: 0.94-17years). Severe complications were found in 48% of patients (11/23), including esophageal perforation (n=11), tracheoesophageal fistula (n=3) and spondylodiscitis (n=1). No patients had vascular injury. Cervical location of the battery was significantly associated with severe complications (10/11 cases). The length of the blooming artifact was greater than 2cm in those with severe complications and, in most cases, <2cm in those without severe complications. All complications were seen on initial screening MR exam with serial exams showing decreased inflammation. MRI/MR angiography can provide valuable information about complications, including esophageal perforation, tracheoesophageal fistula and spondylodiscitis. Decreasing inflammation surrounding the esophagus and vasculature is believed to be clinically reassuring and aids in managing button battery ingestion patients.

Vocal cord paralysis following lithium button battery ingestion in children.

This study reports on vocal cord paralysis caused by esophageal button battery (BB) ingestion in children. Medical records of children with vocal cord paralysis and esophageal BB ingestion treated at a tertiary referral institute between January 2016 and March 2020 were reviewed. Five patients aged 9-58months were identified; three were male. Each patient had accidentally swallowed a 20-mm-diameter lithium battery (3 CR2032 type and 2 CR2025 type). One battery was removed within 4h after ingestion, and three batteries were removed within 12h. Removal of the battery was achieved with rigid esophagoscopy in four patients and direct laryngoscopy in one patient. Four patients had bilateral, and one had unilateral vocal cord paralysis. Three patients underwent tracheotomy; two were tracheotomy-dependent until follow-up, while the third patient died of multiple organ dysfunction syndrome a month after surgery. The two cases without tracheotomy remain under close follow-up.Conclusion: Accidentally ingested button batteries should be removed promptly to avoid severe complications. Respiratory support and neurotrophic treatment in the early stage of vocal cord paralysis may be beneficial for recovery of vocal cord movement. What is Known: • Button battery ingestion in children is extremely harmful, especially when the diameter of the button battery exceeds 20mm. • Esophageal button battery impaction can cause serious complications such as esophageal perforation, mediastinal infection, tracheoesophageal fistula, vocal cord paralysis, and life-threatening bleeding. What is New: • Vocal cord paralysis in children with button battery ingestion plays an early warning role for identifying the severity of the disease. • Early neurotrophic drugs and glucocorticoid therapy may be helpful for the recovery of vocal cord movement, thereby avoiding tracheotomy.

Severe tracheobronchial harm due to lithium button battery aspiration: An in vitro study of the pathomechanism and injury pattern

BackgroundButton battery incidents have become a rising medical issue in recent years, especially for infants. The increasing number of these cases can be explained by the expanding use of objects of everyday life and toys. As a result, button batteries in many households are ubiquitous in different states of charge. The extremely long shelf-life and the increasing energy densities of lithium button batteries boost the potential medical complications of accidental swallowing. ObjectiveThe study aimed to analyze the pathophysiology of damage to tracheobronchial structures by button batteries aspiration over time. MethodsCR2032 and CR927 lithium button batteries (3.2/3.0 V) were exposed to porcine trachea preparations intraluminal at 37 °C in intervals up to 36 h. Measurements were made of the voltage curve, the discharge current, and the resulting pH values around the electrodes. The effects on tissue were examined using macroscopic time-lapse images and microscopic pictures of sections of the fixed specimens over time. FindingsThe examinations showed a tissue electrolysis reaction directly after the beginning of battery exposure, which led to an immediate coagulation impairment of the respiratory epithelium. Over time, a strongly alkaline environment was established around the batteries. The resulting tissue colliquation caused profound tissue damage beyond the basal membrane of the mucosa, affecting the tracheobronchial cartilage after only 4 h of exposure time. After 12 h, there was significant necrosis of the annular ligaments of the trachea and the peribronchial pulmonary tissue. After completion of the experimental exposure time of 36 h, there was still a sufficient residual voltage on all button batteries of the experiments. ConclusionsBesides accidental ingestion, the aspiration of button batteries is a life-threatening situation. The partial or complete acute airway obstruction in the trachea or the bronchi initially is the leading symptom, as with any foreign body aspiration. However, the results of the investigations show that even after a short exposure time, relevant tissue damage can be caused by the electrolysis reaction of the battery. After 12 h, a profound destruction of cartilage, connective tissue, and smooth muscles was observed in vitro, which may cause significant consequential damage in vivo. These findings reveal the need for rapid diagnosis and immediate foreign body removal after any battery ingestion. Moreover, the results show how relevant prevention of these accidents is, and that future safety modifications of these types of battery by the manufacturers would be appropriate.

Mo1980 PEDIATRIC GASTROENTEROLOGY REPORTING PRACTICES FROM FOREIGN BODY AND CAUSTIC INGESTION CASES: DATA AND COLLABORATION TO DRIVE CHANGE

Foreign body (FB) and caustic ingestion events are common conditions managed by pediatric gastroenterologists. Several publicly accessible options exist for providers to report pediatric ingestions. However, industry has deemed existing data sources insufficient for some hazards to justify product safety changes. The objectives of this study were: 1) to capture ingestion injury reporting practices among pediatric gastroenterologists and 2) to discuss a solution. An email survey was sent out to pediatric gastroenterologists asking for: 1) number of years in practice, 2) total number of patients cared for who ingested specific FB’s (button batteries, toys/toy parts, magnets and detergent pods, other), 3) number of cases reported to any data source, and 4) observed morbidity or mortality from specific FBs, 5) if available, would they use a free smartphone application for reporting. 223 responses from pediatric gastroenterologists in practice a mean of 11.4 years (Range: 4 months to 50 years) were analyzed. 17,481 total cases of foreign body and caustic ingestion cases were described. Of these, only 5% of ingestions had been reported. Detergent pod ingestions were most likely to be reported (21%), followed by button batteries (10%), and magnets (10%). Coins, food impactions, and toy/toy parts were reported very infrequently (0-2%). The percent of respondents who had cared for patients with morbidity/mortality due to specific types of ingestions was: 3V lithium button battery (59%), 1.5V non-lithium button battery (22%), toy/toy part (9%), magnet (39%), detergent (19%), other FB (26%). 22% of respondents stated they have not seen cases of morbidity or mortality. 96% stated they would be likely to use a smartphone application to anonymously and efficiently report these injuries. Foreign body and caustic ingestion cases are dramatically underreported by pediatric gastroenterologists, and therefore existing data sources may fail to accurately capture the frequency and severity of these events. This large void in existing cumulative data has limited injury prevention efforts. The Global Injury Research Collaborative (GIRC, www.globalirc.org) is a new non-profit medical research organization dedicated to collection of clinically relevant, anonymous, de-identified injury data around the world via a recently launched free smartphone app platform. All gastroenterologists can contribute to this global centralized database that will help drive safety changes at the respective industry and regulatory levels.

Towards eco-friendly power sources: In series connected glucose biofuel cells power a disposable ovulation test

A disposable ovulation test is operated using a flow stack of 5 in series connected glucose biofuel cells giving an open circuit voltage (OCV) of 3.5 V. Such tests consume at total around 60 μWh of energy and in average 1.7 mW of power during one run of around 12 min which are supplied by a CR1220 3 V lithium button battery in the commercialized device. We replaced this battery by the glucose biofuel cell stack and observed during the measurements and display steps peak currents up to 1.4 mA inducing a voltage drop down to 2.8 V during few seconds (4 mW of power consumption). Even such power peaks are supported by the presented biofuel cell stack assuring the necessary operational cell voltage and current. After the measurements towards Luteinizing Hormone (LH) detection the display remains turned on for 8 min and consumes just 2 μW which allows to reestablish the initial OCV and to run a further test. The presented results demonstrate as proof of concept the suitability of eco-friendly enzymatic glucose biofuel cells as alternative power source for disposable devices.

Predictors of nature of ingested foreign bodies in children & assessment of operative outcomes

ObjectiveTo examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB). MethodsRetrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed. ResultsCases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p < 0.001). Average duration of ingestion: 37/9.5 h (p < 0.001). Patients below 3: 31.3/62.8% (p < 0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p < 0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p = 0.02). LBBFB group: Successful removal in 1st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months. ConclusionsChildren <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.

Button Battery in Esophagus

History of present illness: A 2-year-old male was brought to the emergency department by his parents after a brief choking episode at home and the inability to tolerate oral liquids afterwards. The patient’s mother noticed she was missing a button battery on the counter and suspected her child had swallowed it. On exam, patient had no active drooling or vomiting. His airway was patent with no respiratory distress or stridor. No foreign body was visualized in the oropharynx. Abdominal exam was unremarkable. Significant findings: Chest radiograph showed the presence of a round radiopaque foreign body in the mid- chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin. Discussion: Button battery (BB) ingestion is a potentially very dangerous condition. Over 3,300 exposures are reported annually to the American Poison Control Centers.1 Once a foreign body is ingested, it risks lodging at three anatomically narrow areas of the esophagus: the upper esophageal sphincter or the thoracic inlet (70% of foreign bodies), the aortic notch (20%), and the lower esophageal sphincter (10%).2 If a foreign body becomes lodged in the esophagus, it can cause obstructive-like symptoms such as dysphagia, aspiration, and there is risk of perforation through the esophageal wall.Esophageal foreign bodies can cause dysphagia, aspiration, and perforation; however, BB ingestion causes additional risks of caustic necrosis from the isothermal hydrolysis reaction of the battery against the esophagus lining. Significant caustic burns can occur in as little as two hours after ingestion.1,3 This tissue injury can lead to the development of devastating conditions such as tracheoesophageal fistula, aortoenteric fistula, vocal cord paralysis, and mediastinitis, all of which can be fatal.2 As a result, patients with esophageal BB must undergo emergent direct laryngoscopy and esophagoscopy for removal under direct visualization as soon as possible. 1 This patient underwent esophagoscopy with subsequent removal of a 2 centimeter lithium button battery; direct visualization showed some edema around the mucosa but no signs of stricture or perforation. The patient subsequently tolerated food and was discharged home the next day. Topics: Button battery, esophageal foreign body ingestion.

Pathophysiology of esophageal impairment due to button battery ingestion

BackgroundThe increased use of button batteries with high energy densities in devices of daily life presents a high risk of injury, especially for toddlers and young children. If an accidental ingestion of a button battery occurs, this foreign body can become caught in the constrictions of the esophagus and cause serious damage to the adjacent tissue layers. The consequences can be ulcerations, perforations with fistula formation and damage to the surrounding anatomical structures. In order to gain a better understanding of the pathophysiology after ingestion, we carried out systematic studies on fresh preparations of porcine esophagi. MethodsThe lithium button battery type CR2032, used most frequently in daily life, was exposed in preparations of porcine esophagi and incubated under the addition of artificial saliva at 37 °C. A total of eight esophagi were analysed by different methods. Measurements of the pH value around the battery electrodes and histological studies of the tissue damage were carried out after 0.5–24 h exposure time. In addition, macroscopic time-lapse images were recorded. Measurements of the battery voltage and the course of the electric current supplemented the experiments. FindingsThe investigations showed that the batteries caused an electrolysis reaction in the moist environment. The positive electrode formed an acidic and the negative electrode a basic medium. Consequently, a coagulation necrosis at the positive pole, and a deep colliquation necrosis at the minus pole occurred. After an exposure time of 12 h, tissue damage caused by the lye corrosion was observed on the side of the negative electrode up to the lamina muscularis. The corrosion progressed up to the final exposure time of 24 h, but the batteries still had sufficient residual voltage, such that further advancing damage would be expected. ConclusionsButton battery ingestion in humans poses an acute life-threatening danger and immediate endoscopic removal of the foreign body is essential. After only 2 h exposure time, significant damage to the tissue could be detected, which progressed continuously to complete esophageal perforation. The primary prevention of battery ingestion is therefore of particular importance.

Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal.

Button battery (BB) injuries continue to be a significant source of morbidity and mortality, and there is a need to confirm the mechanism of injury for development of additional mitigation strategies. Cadaveric piglet esophageal model. Lithium, silver oxide, alkaline, and zinc-air BBs were placed in thawed sections of cadaveric piglet esophagus, bathed in normal saline. Severity of gross visual burn, pH, and temperature were recorded every 30 minutes for 6 hours. In other esophageal tissue specimens, the lithium BB was removed after 24, 36, and 48 hours and the site was irrigated with either 0.25% or 3% acetic acid. Separately, ReaLemon® juice, orange juice, Coke®, Dasani® water, Pepsi®, and saline were infused over a vertically suspended esophagus with a CR2032 lithium battery every 5 minutes for 2 hours while tissue temperature and pH were measured. A gradual rise in tissue pH and minimal change in temperature was noted for all BBs. ReaLemon® and orange juice applied every 5 minutes were most effective at neutralization of tissue pH with minimal change in tissue temperature. After BB removal (24, 36, 48 hours), irrigation of esophageal tissue specimens with 50-150 mL 0.25% acetic acid neutralized the highly alkaline tissue pH. BB appear to cause an isothermic hydrolysis reaction resulting in an alkaline caustic injury. Potential new mitigation strategies include application of neutralizing weakly acidic solutions that may reduce esophageal injury progression. NA Laryngoscope, 127:1276-1282, 2017.

Spondylodiscitis After Ingestion of a Lithium Button Battery: A Case Report.

Ingestion of a foreign body is a common problem in the pediatric population. Disc or button batteries represent an important category of foreign body ingestion because of the potential for serious complications if they are not removed promptly. Although the incidence of ingestions involving button batteries has leveled off, the frequency of serious complications from these ingestions has continued to rise1. Orthopaedic sequelae, however, remain rare1. We present the case of a nineteen-month-old girl who developed spondylodiscitis after ingesting a lithium button battery. The patient’s family was informed that data concerning the case would be submitted for publication, and they provided consent. A nineteen-month-old girl presented to the emergency department as a transfer from another hospital after chest radiographs showed a 20-mm disc-shaped foreign body lodged in the esophagus (Figs. 1-A and 1-B). The parents reported that the child had decreased oral intake and increased salivation over the twenty-four hours before presentation. The patient was urgently taken to the operating room and underwent the uncomplicated removal of a lithium button battery under direct visualization with a rigid esophagoscope. During the procedure, it was noted that there was substantial coagulative necrosis around the esophagus and around the foreign body, suggesting that it had been present for a prolonged period of time. The area of necrosis appeared to be less than full thickness in extent. On the first postoperative day, the patient underwent an esophagogram that was consistent with esophageal inflammation; there was no leakage of contrast. She was slowly advanced from a clear liquid diet, as recommended by the National Battery Ingestion Hotline of the National Capital Poison Center, and was discharged to home uneventfully. Fig. 1 Anteroposterior ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs at initial presentation showing the button battery lodged in the esophagus. The patient initially …

Button battery ingestion in children: An emerging hazard

AbstractButton battery ingestion is an emerging hazard. In this retrospective study, we report six cases of lithium button battery ingestion in pediatric age group (mean age 2.8 years). Three button batteries were removed from stomach and three from esophagus. Esophageal site was associated with significant local injury, and one button battery was impacted in the esophagus, requiring rigid esophagoscopy for removal. Small battery size, used batteries, and early removal (&lt;12 h after ingestion) were associated with lesser mucosal injury. No long-term complications were noted. Our study emphasizes that early diagnosis and urgent removal of ingested button battery are the only measures which prevent complications.

Tension pneumothorax and subcutaneous emphysema during retrieval of an ingested lithium button battery

We present a case of a child with an ingested lithium battery causing esophageal perforation with mediastinal injury extending to the pleural cavity. During the endoscopic retrieval of the battery, the child developed the rare complication of subcutaneous emphysema, tension pneumothorax, and pneumomediastinum from excessive iatrogenic air insufflation. The patient developed mediastinitis and had a complicated postoperative course.

High-rhythm automatic driver for bone traction: an experimental study in rabbits

The distractors currently used in clinics are activated manually by intermittent advancement. An automatic driver has been developed to attach to custom-made or commercially available distractors and activate advancement at a high rhythm of 8 steps per second. One 1.5-V lithium button battery is used as the power source to drive a step motor and the driving torque is transmitted to the distractor through a flexible shaft at a rate of 2 revolutions per day. This automatic driver was tested in 5 rabbits for mandibular lengthening. Osteotomy was performed on one side of the mandible and the custom-made distractor was adapted. After a latency period of 3 days, the automatic driver was attached to the distractor's arm and mandibular lengthening was activated. After 11 days of continuous distraction the automatic driver was detached from the distractor's arm. All the rabbits were euthanized after 4 weeks of consolidation. The distraction regenerates were analysed by plain radiography, micro-computerized tomography and histological examination. All 5 rabbits completed the experimental process and healed uneventfully. The mandibles were confirmed to have lengthened successfully and the distraction gap was filled with newly formed bone.

Systemic absorption of lithium following ingestion of a lithium button battery

Accidental ingestion of electrical batteries occurs commonly in children. This rarely is associated with severe morbidity and mortality. Significant symptoms can arise due to leakage of alkali or heavy metals from the battery after degradation in the gastrointestinal tract. The main heavy metal of concern in electrical batteries is mercury; this is the first report of ingestion of a lithium battery in a child associated with systemic absorption of lithium.