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Hiccups
From WikEM
Contents
Background
- Usually initiated by gastric distention from food, carbonated beverage, or air
- Also known as Singultus
Definitions
- Hiccup bout: >48 hours
- Persistent hiccups: 48 hours to 1 month
- Intractable hiccups: >1 month
Clinical Features
- Hiccups
Differential Diagnosis
Hiccups
- Central nervous system disorders
- Vascular
- Ischemic/hemorrhagic stroke
- AV malformations
- Temporal arteritis
- Infections
- Encephalitis
- Meningitis
- Brain abscess
- Neurosyphillis
- Subphrenic abscess
- Structural
- Head trauma
- Intracranial neoplasm
- Brainstem neoplasms
- Multiple sclerosis
- Syringomyelia
- Hydrocephalus
- Vagus and phrenic nerve irritation
- Goiter
- Pharyngitis
- Laryngitis
- Hair or foreign body irritation of tympanic membrane
- Neck cyst or other tumor
- Vascular
- Gastrointestinal disorders
- Gastric distention
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Pancreatic cancer
- Gastric carcinoma
- Abdominal abscesses
- Gallbladder disease
- Inflammatory bowel disease
- Hepatitis
- Aerophagia
- Esophagael distention
- Esophagitis
- Bowel obstruction
- Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm
- Pneumonia
- Empyema
- Bronchitis
- Asthma
- Pleuritis
- Aortic aneurysm
- Mediastinitis
- Mediastinal tumors
- Chest trauma
- Pulmonary embolism
- Cardiovascular disorders
- Toxic-metabolic
- Postoperative
- General anesthesia
- Intubation (stimulation of glottis)
- Neck extension (stretching phrenic nerve roots)
- Gastric distention
- Traction on viscera
- Drugs
- Alpha methyldopa
- Short-acting barbituates
- Chemotherapeutic agents (eg, carboplatin)
- Dexamethasone
- Diazepam
- Psychogenic
- Anorexia nervosa
- Conversion reaction
- Excitement
- Malingering
- Schizophrenia
- Stress
Evaluation
- Clinical diagnosis
- Consider auditory canal exam (foreign body against TM can trigger hiccups)
- Hyponatremia and hypocalcemia
- Consider CXR
Management
- Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
- Remove foreign body from ear
- Swallow teaspoon of sugar
- Sip ice water
- Drink water quickly
- Meds
- Chlorpromazine 25–50mg IV; 25–50mg PO TID
- Metoclopramide 10mg IV or IM; 10–20mg PO TID x 10d
Disposition
- Discharge for uncomplicated hiccups
See Also
References
Authors
Ross Donaldson, Jordan Swartz, Michael Holtz, Daniel Eggeman, Claire, Kevin Lu, Neil Young
