Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-03: Hiccups (Singultus) + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Detailed neurologic examination + Diagnosis Download Section PDF Listen +++ ++ Serum creatinine, liver chemistry tests Chest radiograph CT or MRI of the head, chest, abdomen Echocardiography Upper endoscopy + Treatment Download Section PDF Listen +++ +++ 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