What are the three common types of batteries?
-dry cell
-button
-lithium ion
What are the toxic effects of dry cell batteries?
-gray/black staining of the teeth
-liquefactive necrosis
-severe, deep ulcers
-heavy metal toxicity
What are the toxic effects of button/lithium ion batteries?
-corrosive to GI mucosa due to electrical discharge (LI batteries more so)
-tissue necrosis (LI > button)
-heavy metal toxicity
What are the clinical signs of battery toxicity?
-onset within 1 to 12 hours
-hypersalivation
-erythema of mucous membranes
-oral pain/pawing at mouth
-head shaking
-abdominal pain
-abdominal distention/effusion
Which diagnostics are used in cases of suspected battery ingestion?
-radiographs
-baseline blood work (non-specific changes)
What are the management steps for battery ingestion?
-do NOT induce vomiting
-endoscopic or surgical removal
-can try to allow small dry cell batteries to pass naturally
-GI protectants: H2 blockers, PPIs
-pain medications
-feeding tube if anorexic due to damage
What is the prognosis for battery ingestion?
-good with minimal clinical signs
-guarded if severe GI bleeding or perforation
What are the clinical signs of diisocyanate glue/gorilla glue ingestion?
-signs within 15 minutes to 20 hours
-GI ulceration
-vomiting
-anorexia
-abdominal pain
-foreign body obstruction due to glue expansion
-respiratory irritation if inhaled
Which diagnostics are used in cases of diisocyanate glue ingestion?
-blood work (non-specific changes)
-radiographs
What are the treatment steps for diisocyanate glue ingestion?
-induction of emesis only if IMMEDIATELY after ingestion
-gastric lavage is ineffective
-exploratory surgery to remove glue foreign body
What is the prognosis for diisocyanate glue ingestion?
-good prognosis
-75% of cases do require surgery
Which glue products are of minimal toxic concern?
*polyvinyl acetates/Elmer’s glue
-causes mild, self-limiting GI upset
*glue traps
-not toxic, just sticky
-removed by cutting hair or applying cooking oil
Which items can cause zinc toxicity?
-pennies (after 1982)
-metallic nuts
-bolts
-galvanized cages
-nails
-staples
-jewelry
-zippers
-ointments
-supplements
What are the toxic effects of zinc?
-direct damage to RBC membranes and organelles
-immune-mediated destruction from hapten formation
-inhibition of specific RBC biochemical mechanisms
-accumulates in pancreas, liver, kidney, and spleen
What are the clinical signs of zinc toxicity?
-anorexia
-vomiting
-diarrhea
-lethargy
-pale/icteric mucus membranes
-tachycardia
-tachypnea
-icteric sclera/skin
-hemoglobinuria
-seizures
What are the diagnostic findings in zinc toxicity?
*CBC:
-hemolytic anemia
-heinz bodies +/- spherocytosis
-leukocytosis
-thrombocytopenia
*CHEM:
-increased liver enzymes
-increased Tbili
-increased amylase and lipase
-azotemia
*UA:
-bilirubinuria
-hemoglobinuria
-isosthenuria
-proteinuria
-casts
*Radiographs:
-metal foreign body
How is zinc toxicity managed?
-emesis
-gastric lavage
-endoscopy/surgery
-IV fluids
-packed RBC transfusion
-antacids and antiemetics
-chelation therapy with CaNa2EDTA
What is the prognosis for zinc toxicity?
variable; depends on length of time zinc is in body
What are the potential sources of ethylene glycol?
-radiator antifreeze
-brake fluid
-basketball goal post bases
-de-icers
What is the mechanism of toxicity for ethylene glycol?
-biotransformation produces metabolites that are more toxic than parent compound
-ethylene glycol and glycoaldehyde cause CNS signs
-glycolic and glyoxylic acids cause metabolic acidosis and nephrotoxicity
-glycolic and glyoxylic acids accumulate due to aldehyde dehydrogenase saturation
-mechanical renal damage due to calcium oxalate crystals
What are the clinical signs of ethylene glycol toxicity during the neurologic phase (30 minutes to 12 hours)?
-“drunkenness”
-CNS depression
-ataxia
-PUPD
-hypothermia
-vomiting
-seizures
-coma
metabolic acidosis
-possible death
-calcium oxalate crystalluria
-followed by apparent recovery
What are the signs of ethylene glycol toxicity during the cardiopulmonary phase (12 to 24 hours)?
-tachypnea
-tachycardia
-depression
-pulmonary edema
-continued metabolic acidosis
What are the signs of ethylene glycol toxicity during the renal phase (24 to 72 hours)?
-azotemia
-depression
-vomiting
-diarrhea
-abdominal pain
-oral ulceration
-oliguria/anuria
-seizures
-death
Which venous blood gas and electrolyte tests indicate ethylene glycol toxicity?
-severe metabolic acidosis
-increased serum osmolality
-increased anion gap
-possible hypocalcemia
-possible hyperglycemia
