Hiccups: Difference between revisions

Latest revision as of 22:31, 21 September 2022

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
  - Neurosyphilis
  - 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
Gastrointestinal disorders
- Gastric distention
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Pancreatic cancer
- Gastric carcinoma
- Abdominal abscesses
- Gallbladder disease
- Inflammatory bowel disease
- Hepatitis
- Aerophagia
- Esophageal distention
- Esophagitis
- Bowel obstruction
Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm
- Pneumonia
- Empyema
- Bronchitis
- Asthma
- Pleuritis
- Aortic dissection
- Mediastinitis
- Mediastinal tumors
- Chest trauma
- Pulmonary embolism
Cardiovascular disorders
- Myocardial infarction
- Pericarditis
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 barbiturates
- 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)
Consider 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
- Initiating pharmacologic treatment with a proton pump inhibitor. Alternative first-line agents include baclofen, gabapentin, and metoclopramide^[1]

Disposition

Discharge for uncomplicated hiccups

References

↑ Lembo et al. Hiccups. Uptodate.https://www.uptodate.com/contents/hiccups?search=Hiccups&source=search_result&selectedTitle=1~41&usage_type=default&display_rank=1#H1014341651

Authors:

[1] Lembo et al. Hiccups. Uptodate.https://www.uptodate.com/contents/hiccups?search=Hiccups&source=search_result&selectedTitle=1~41&usage_type=default&display_rank=1#H1014341651

[1]

@@ Line 1: / Line 1: @@
 ==Background==
-Also known as Singultus
+*Usually initiated by gastric distention from food, carbonated beverage, or air
+*Also known as Singultus
-==Workup==
+===Definitions===
-#CBC
+*Hiccup bout: <48 hours
-#Chem 10
+*Persistent hiccups: 48 hours to 1 month
-#CXR (?CT diaphram)
+*Intractable hiccups: >1 month
-#LFTs
-#Lipase
-#?Head-CT
-#ECG
-==Treatment ==
+==Clinical Features==
-#Vagal maneuvers
+*Hiccups
-#Thorazine
-#Reglan
+==Differential Diagnosis==
-#Haldol
+===Hiccups===
+*Central nervous system disorders
+**Vascular
+***Ischemic/hemorrhagic [[stroke]]
+***AV malformations
+***[[Temporal arteritis]]
+**Infections
+***[[Encephalitis]]
+***[[Meningitis]]
+***[[Brain abscess]]
+***[[Neurosyphilis]]
+***Subphrenic abscess
+**Structural
+***[[Head trauma]]
+***[[Intracranial neoplasm]]
+***Brainstem neoplasms
+***[[Multiple sclerosis]]
+***[[Syringomyelia]]
+***[[Hydrocephalus]]
+**Vagus and phrenic nerve irritation
+***[[thyroid disease|Goiter]]
+***[[Pharyngitis]]
+***[[Laryngitis]]
+***Hair or foreign body irritation of tympanic membrane
+***Neck cyst or other tumor
+*Gastrointestinal disorders
+**Gastric distention
+**[[Gastritis]]
+**[[Peptic ulcer disease]]
+**[[Pancreatitis]]
+**Pancreatic cancer
+**Gastric carcinoma
+**Abdominal abscesses
+**[[Gallbladder disease]]
+**[[Inflammatory bowel disease]]
+**[[Hepatitis]]
+**Aerophagia
+**Esophageal distention
+**[[Esophagitis]]
+**[[Bowel obstruction]]
+*Thoracic disorders
+**Enlarged lymph nodes secondary to infection or neoplasm
+**[[Pneumonia]]
+**[[Empyema]]
+**[[Bronchitis]]
+**[[Asthma]]
+**[[Pleuritis]]
+**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
+**[[Mediastinitis]]
+**Mediastinal tumors
+**[[Chest trauma]]
+**[[Pulmonary embolism ]]
+*Cardiovascular disorders
+**[[Myocardial infarction]]
+**[[Pericarditis]]
+*Toxic-metabolic
+**[[Alcohol intoxication]]
+**[[Diabetes mellitus]]
+**[[Herpes zoster]]
+**[[Hypocalcemia]]
+**[[Hypocapnia]]
+**[[Hyponatremia]]
+**[[Influenza]]
+**[[Malaria]]
+**[[Tuberculosis]]
+**[[Uremia]]
+*Postoperative
+**General anesthesia
+**[[Intubation]] (stimulation of glottis)
+**Neck extension (stretching phrenic nerve roots)
+**Gastric distention
+**Traction on viscera
+*Drugs
+**Alpha methyldopa
+**Short-acting [[barbiturates]]
+**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)
+*Consider [[Hyponatremia]] and [[Hypocalcemia]]
+*Consider [[CXR]]
+==Management==
+*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
+**Remove [[ear foreign body|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
+**Initiating pharmacologic treatment with a [[proton pump inhibitor]]. Alternative first-line agents include [[baclofen]], [[gabapentin]], and [[metoclopramide]]<ref>Lembo et al. Hiccups. Uptodate.https://www.uptodate.com/contents/hiccups?search=Hiccups&source=search_result&selectedTitle=1~41&usage_type=default&display_rank=1#H1014341651 </ref>
+==Disposition==
+*Discharge for uncomplicated hiccups
+==See Also==
+==References==
+<references/>
 [[Category:GI]]
+[[category:Symptoms]]