title: Release of toxic metals from button batteries retained in the stomach: An in vitro study.
abstract: BACKGROUND
  Ingestion of button batteries by children is a rapidly growing problem, and opinions differ on how button batteries distal to the gastroesophageal junction should be managed. The authors therefore performed an experimental study to determine the cumulative load of various toxic elements released from retained button cells in simulated gastric juice.
  
  
  METHODS
  Eight different groups of button cells were immersed in simulated gastric juice. Analyzed elements included Al, Ba, Cd, Cr, Cu, Fe, Hg, Li, Mg, Mn, Ni, Pb, Sb, Sn, Sr, Te, TI, V, W; and Zn. Inductively coupled plasma mass spectrometry (ICP-MS) was used to evaluate the residual amounts of elements after 4, 24, 72, and 120 hours.
  
  
  RESULTS
  At 4 hours, leakage was seen with almost all batteries, with the levels increasing in a time-dependent manner. The highest detected levels at 4 hours were 1.20 microgram for Cd, 280.51 ng for Hg, and 2.63 microgram for Pb. Dissolution, holes, and defragmentation were seen within 24 to 72 hours. Battery weight loss varied between 22 and 104 mg over the course of the study.
  
  
  CONCLUSIONS
  Toxic elements contained in button cells are released quickly in gastric juice. This finding might change the current policy of watchful waiting or conservative management of batteries lodged in the stomach.
authors.affiliation: Department of Paediatrics, Royal Aberdeen Children's Hospital, Foresterhill, Aberdeen, Scotland.
authors.forename: Winfried
authors.initials: W
authors.lastname: Rebhandl
authors.forename: Ilse
authors.initials: I
authors.lastname: Steffan
authors.forename: Peter
authors.initials: P
authors.lastname: Schramel
authors.forename: Stefan
authors.initials: S
authors.lastname: Puig
authors.forename: Kurosh
authors.initials: K
authors.lastname: Paya
authors.forename: Erhard
authors.initials: E
authors.lastname: Schwanzer
authors.forename: Birgit
authors.initials: B
authors.lastname: Strobl
authors.forename: Ernst
authors.initials: E
authors.lastname: Horcher
mesh_terms: D011211:Electric Power Supplies; D005547:Foreign Bodies / Q000150:complications; D005750:Gastric Juice / Q000737:chemistry*; D019216:Metals, Heavy / Q000737:chemistry*; D019565:Metals, Light / Q000737:chemistry*; D013270:Stomach; D013997:Time Factors
chemical_list: D019216:Metals, Heavy; D019565:Metals, Light