Dr. Greene, we need medical assistance -- hurry! The situation is as follows: - A little girl, 11 months, arrived to the Children's Hospital. She had eaten a battery of a remote control (TV) that was picked up after 12 hours in the esophagus.
There was an intoxication with mercury and acid. The situation now is perforations in windpipe and esophagus, with septicemia. She is in the intensive therapy, seriously but stable.
We need information about:

• similar cases in the world
• possible antidotes
• products the battery contains and their effects when they're eaten.

Also we need a pediatrician's assistance, specialized in intensive therapy or similar specialties. Every information will be useful.

How agonizing for the parents to watch their daughter suffer so! And over a tragedy that came so close to not being a problem.

Babies love to explore the world with their mouths. This is especially true of infants during those precious, fleeting months that they crawl across the floor, but is common for kids up to the age of 4. These young children will come upon something interesting, and then put it in their mouths to sample. Most of these episodes are nothing more than happy parts of growing up.

Sometimes, however, the attractive object can poison or choke the child. In the United States approximately 1.4 million childhood poisonings are reported each year -- most commonly from cosmetics or personal care products, cleaning or polishing agents, plants, pesticides, fertilizers, foreign bodies and medicines (2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System, Clinical Toxicology, Dec 2007). And choking is the most common cause of accidental death in children under the age of one.

Very enticing are smooth, bright, shiny objects such as batteries -- especially the small disc-shaped batteries now found in many cameras, watches and electronic devices. These little buttons look harmless, but can be quite lethal. The same is true of larger batteries, but they are less frequently swallowed. According to the National Capital Poison Center, 3,500 people swallow button batteries each year (www.poison.org/battery/).

In the United States there is a 24-hour emergency consultation service called the National Button Battery Ingestion Hotline (202-625-3333). Over a 7-year period they followed 2382 cases of swallowed batteries. Of these, 62 were larger cylindrical batteries, and the rest were buttons. Hearing aids were the most common source of batteries swallowed. Most kids who swallowed batteries had no problems. Only 9.9% had symptoms suggesting injury (abdominal pain, vomiting, bloody stools). In this series, only 2 children had very severe esophageal burns (Pediatrics, Apr 4, 1992).

Batteries contain powerful alkaline corrosives that can cause severe burns if they leak inside the body. Different batteries contain different ingredients. Among the most common are lithium, manganese dioxide, silver oxide, and zinc. Of these, lithium and manganese dioxide usually cause the most severe burns.

Mercuric oxide batteries were once a major concern, but the United States government banned them in 1996. When the mercuric oxide batteries leak and fragment, they can cause mercury intoxication as well as burns. Mercury poisoning creates a wide variety of problems, but often begins with vomiting, bloody diarrhea, and severe abdominal pain. It can proceed to decay of the walls of the intestines, vomiting blood, shock, and death. Chronic exposure to high levels of mercury salts causes irritability, kidney disease, colitis, and drooling.