Dangers and Treatments for Household Battery Ingestion
In today's households there are generally a few common battery types—alkaline, disc and rechargeable—and all present risks to pets who are exposed to them.
Alkaline batteries contain potassium hydroxide and thus have a very high pH. Ingestion of alkaline or caustic substances, like the contents of batteries, can cause liquefactive necrosis of tissues.
Liquefactive necrosis affects the fat in the cell membrane causing cell destruction and ultimately deeper penetration into mucosal tissues. Although the degree of damage can vary, the potential for ulceration from batteries is high.
Ulceration can be seen as early as 1-2 hours post exposure, but the full extent of the caustic injury can take up to 24 hours to be seen. Clinical signs for oral exposures include dysphagia, hypersalivation, stridor, vomiting, oral and/or abdominal pain, oropharyngeal edema, lethargy, depression, dyspnea and white to grey erosions or ulceration that may slough.
Often the owner will note a liquid leaking from the battery when it has been punctured.
Disc or button batteries can be found in watches, hearing aids, small electronic devices or toys. When chewed open they have the same caustic injury concern as alkaline batteries, but when swallowed intact they do have additional concerns.
Depending on the size of the battery and the size of the patient, obstruction of either the esophagus or trachea (if aspirated) is a possible, but not common, concern. Furthermore, if the battery is retained in the esophagus it can cause burns due to its ability to emit a small electrical current.
Emesis and activated charcoal are not typically recommended when dealing with a battery exposure, since leaking batteries can cause additional corrosive injury if emesis is induced. Additionally, activated charcoal is not indicated, as the alkalis work locally and are not absorbed.
Batteries that are leaking or stuck in the esophagus can either be removed by endoscopy or, if in the stomach, removed via gastrotomy. If the battery is in the stomach adding extra fiber to the diet and monitoring for the passage of the battery is a reasonable approach, particularly if the battery appears intact or is a disc battery.
Radiographs may be indicated if whole batteries or large pieces of the cases were ingested to determine the location of the battery and if they are moving through the GI tract. In some cases, it can also be determined if the batteries are leaking or not.
Treatment for battery exposures is symptomatic and supportive. As long as the patient is eating and drinking on his own, is not significantly hyperthermic, does not have leukocyotosis or leukopenia, he can likely be monitored on an outpatient basis.
Gastroprotectants: Omeprazole and sucralfate slurries are recommended for the treatment of oral, esophageal and GI ulceration.
Fluid therapy: If the patient is unable to drink or is hyperthermic, IV fluids can be very beneficial.
Pain control: Opioids are recommended. NSAIDs can potentially worsen ulcerations are not recommended for the treatment of pain in patients exposed to alkalis.
Nutritional support: A gastrotomy tube may be indicated in anorexic patients.
Corticosteroids: Use is controversial, but a single, short acting dose might be considered in patients with signs of severe inflammation.
Broad spectrum antibiotics: If there are signs of erosions or ulcerations to help prevent secondary bacterial translocation and infection.
When it comes to battery exposures there are a few parameters that may need monitoring. Leukocytosis can be seen and in more severe cases where perforation is a concern, a complete blood cell count should be monitored.
Hyperthermia, ranging from mild to severe, can be seen as an inflammatory response due to tissue damage. While not common, there may be risk for esophageal strictures that can take up to 4-6 weeks to be seen.