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
***AV malformations
***Temporal arteritis
***[[Temporal arteritis]]
**Infections
**Infections
***Encephalitis
***[[Encephalitis]]
***Meningitis
***[[Meningitis]]
***Brain abscess
***[[Brain abscess]]
***Neurosyphillis
***[[Neurosyphilis]]
***Subphrenic abscess
***Subphrenic abscess
**Structural
**Structural
***Head trauma
***[[Head trauma]]
***intracranial neoplasms
***[[Intracranial neoplasm]]
***brainstem neoplasms
***Brainstem neoplasms
***multiple sclerosis
***[[Multiple sclerosis]]
***syringomyelia
***[[Syringomyelia]]
***hydrocephalus
***[[Hydrocephalus]]
**Vagus and phrenic nerve irritation
**Vagus and phrenic nerve irritation
***Goiter
***[[thyroid disease|Goiter]]
***pharyngitis
***[[Pharyngitis]]
***laryngitis
***[[Laryngitis]]
***hair or foreign body irritation of tympanic membrane
***Hair or foreign body irritation of tympanic membrane
***neck cyst or other tumor
***Neck cyst or other tumor
*Gastrointestinal disorders
*Gastrointestinal disorders
**Gastric distention
**Gastric distention
**gastritis
**[[Gastritis]]
**peptic ulcer disease
**[[Peptic ulcer disease]]
**pancreatitis
**[[Pancreatitis]]
**pancreatic cancer
**Pancreatic cancer
**gastric carcinoma
**Gastric carcinoma
**abdominal abscesses
**Abdominal abscesses
**gallbladder disease
**[[Gallbladder disease]]
**inflammatory bowel disease
**[[Inflammatory bowel disease]]
**hepatitis, aerophagia
**[[Hepatitis]]
**esophagael distention
**Aerophagia
**esophagitis
**Esophageal distention
**bowel obstruction
**[[Esophagitis]]
**[[Bowel obstruction]]
*Thoracic disorders
*Thoracic disorders
**Enlarged lymph nodes secondary to infection or neoplasm
**Enlarged lymph nodes secondary to infection or neoplasm
**pneumonia
**[[Pneumonia]]
**empyema
**[[Empyema]]
**bronchitis
**[[Bronchitis]]
**asthma
**[[Asthma]]
**pleuritis
**[[Pleuritis]]
**aortic aneurysm
**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
**mediastinitis
**[[Mediastinitis]]
**mediastinal tumors
**Mediastinal tumors
**chest trauma
**[[Chest trauma]]
**pulmonary embolism  
**[[Pulmonary embolism ]]
*Cardiovascular disorders
*Cardiovascular disorders
**Myocardial infarction
**[[Myocardial infarction]]
**pericarditis
**[[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 barbituates
**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


==Diagnosis==
==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

Evaluation

  • Clinical diagnosis
  • Consider auditory canal exam (foreign body against TM can trigger hiccups)
  • Consider Hyponatremia and Hypocalcemia
  • Consider CXR

Management

Disposition

  • Discharge for uncomplicated hiccups

See Also

References

  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
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