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Key Features

  • Usually benign and self-limited but may be persistent and a sign of serious underlying illness

  • Causes of self-limited hiccups

    • Gastric distention

    • Sudden temperature changes

    • Alcohol ingestion

    • Heightened emotion

  • Causes of recurrent or persistent hiccups

    • Neoplasms, infections, cerebrovascular accident, trauma

    • Uremia, hypocapnia (hyperventilation)

    • Irritation of the vagus or phrenic nerve

      • Foreign body in ear, goiter, neoplasms

      • Pneumonia, empyema, neoplasms, myocardial infarction, pericarditis, aneurysm, esophageal obstruction, reflux esophagitis

      • Subphrenic abscess, hepatomegaly, hepatitis, cholecystitis, gastric distention, gastric neoplasm, pancreatitis, pancreatic malignancy

    • General anesthesia, postoperative

    • Psychogenic and idiopathic

Clinical Findings

  • Detailed neurologic examination

Diagnosis

  • Serum creatinine, liver chemistry tests

  • Chest radiograph

  • CT or MRI of the head, chest, abdomen

  • Echocardiography

  • Upper endoscopy

Treatment

Acute hiccups

  • Irritating nasopharynx by catheter stimulation or tongue traction, lifting uvula with a spoon, or eating 1 teaspoon (4–8 g) dry granulated sugar

  • Interrupting respiratory cycle by

    • Breath holding

    • Valsalva maneuver

    • Sneezing

    • Gasping

    • Rebreathing into bag

  • Stimulating vagus nerve by carotid massage

  • Irritating diaphragm by holding knees to chest or by continuous positive airway pressure during mechanical ventilation

  • Relieving gastric distention by belching or insertion of a nasogastric tube

Chronic hiccups

  • Chlorpromazine, 25–50 mg three or four times daily orally or intramuscularly

  • Anticonvulsants (phenytoin, carbamazepine)

  • Benzodiazepines (lorazepam, diazepam)

  • Metoclopramide

  • Baclofen

  • Gabapentin

  • Occasionally general anesthesia

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