Hiccups

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

  • Central nervous system: Neoplasms, infections, cerebrovascular accident, trauma

  • Metabolic: 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, COVID-19 infection (atypical presentation)

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

  • Surgical: 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

• For severe, intractable hiccups

  • Phrenic nerve block

  • Vagal nerve stimulation

  • General anesthesia