Hiccups: Difference between revisions
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==Background== | ==Background== | ||
*Usually initiated by gastric distention from food, carbonated beverage, or air | *Usually initiated by gastric distention from food, carbonated beverage, or air | ||
*Also known as Singultus | *Also known as Singultus | ||
===Definitions=== | |||
*Hiccup bout: <48 hours | |||
*Persistent hiccups: 48 hours to 1 month | |||
*Intractable hiccups: >1 month | |||
==Clinical Features== | ==Clinical Features== | ||
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*Central nervous system disorders | *Central nervous system disorders | ||
**Vascular | **Vascular | ||
***Ischemic/hemorrhagic stroke | ***Ischemic/hemorrhagic [[stroke]] | ||
***AV malformations | |||
***[[Temporal arteritis]] | |||
**Infections | **Infections | ||
***Encephalitis | ***[[Encephalitis]] | ||
***[[Meningitis]] | |||
***[[Brain abscess]] | |||
***[[Neurosyphilis]] | |||
***Subphrenic abscess | |||
**Structural | **Structural | ||
***Head trauma | ***[[Head trauma]] | ||
***[[Intracranial neoplasm]] | |||
***Brainstem neoplasms | |||
***[[Multiple sclerosis]] | |||
***[[Syringomyelia]] | |||
***[[Hydrocephalus]] | |||
**Vagus and phrenic nerve irritation | **Vagus and phrenic nerve irritation | ||
***Goiter | ***[[thyroid disease|Goiter]] | ||
***[[Pharyngitis]] | |||
***[[Laryngitis]] | |||
***Hair or foreign body irritation of tympanic membrane | |||
***Neck cyst or other tumor | |||
*Gastrointestinal disorders | *Gastrointestinal disorders | ||
**Gastric distention | **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 | *Thoracic disorders | ||
**Enlarged lymph nodes secondary to infection or neoplasm* | **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 | *Cardiovascular disorders | ||
**Myocardial infarction | **[[Myocardial infarction]] | ||
**[[Pericarditis]] | |||
*Toxic-metabolic | *Toxic-metabolic | ||
**Alcohol | **[[Alcohol intoxication]] | ||
**Diabetes mellitus | **[[Diabetes mellitus]] | ||
**Herpes zoster | **[[Herpes zoster]] | ||
**Hypocalcemia | **[[Hypocalcemia]] | ||
**Hypocapnia | **[[Hypocapnia]] | ||
**Hyponatremia | **[[Hyponatremia]] | ||
**Influenza | **[[Influenza]] | ||
**Malaria | **[[Malaria]] | ||
**Tuberculosis | **[[Tuberculosis]] | ||
**Uremia | **[[Uremia]] | ||
*Postoperative | *Postoperative | ||
**General anesthesia | **General anesthesia | ||
**Intubation (stimulation of glottis) | **[[Intubation]] (stimulation of glottis) | ||
**Neck extension (stretching phrenic nerve roots) | **Neck extension (stretching phrenic nerve roots) | ||
**Gastric distention | **Gastric distention | ||
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*Drugs | *Drugs | ||
**Alpha methyldopa | **Alpha methyldopa | ||
**Short-acting | **Short-acting [[barbiturates]] | ||
**Chemotherapeutic agents (eg, carboplatin) | **Chemotherapeutic agents (eg, carboplatin) | ||
**Dexamethasone | **[[Dexamethasone]] | ||
**Diazepam | **[[Diazepam]] | ||
*Psychogenic | *Psychogenic | ||
**Anorexia nervosa | **[[Anorexia nervosa]] | ||
**Conversion reaction | **[[Conversion reaction]] | ||
**Excitement | **Excitement | ||
**Malingering | **Malingering | ||
**Schizophrenia | **[[Schizophrenia]] | ||
**Stress | **Stress | ||
== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Consider auditory canal exam (foreign body against TM can trigger hiccups) | *Consider auditory canal exam (foreign body against TM can trigger hiccups) | ||
*Consider CXR | *Consider [[Hyponatremia]] and [[Hypocalcemia]] | ||
*Consider [[CXR]] | |||
==Management== | ==Management== | ||
*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc) | *Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc) | ||
**Remove foreign body from ear | **Remove [[ear foreign body|foreign body]] from ear | ||
**Swallow teaspoon of sugar | **Swallow teaspoon of sugar | ||
**Sip ice water | **Sip ice water | ||
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**[[Chlorpromazine]] 25–50mg IV; 25–50mg PO TID | **[[Chlorpromazine]] 25–50mg IV; 25–50mg PO TID | ||
**[[Metoclopramide]] 10mg IV or IM; 10–20mg PO TID x 10d | **[[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== | ==Disposition== | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[category:Symptoms]] | |||
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
- Vascular
- 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
- 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