hiccups (singultus)
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Introduction
Repetitive, sharp inspiratory sounds associated with spasm of the glottis, diaphragm & intercostal muscles.
The term derives from the sound of the event.
The medical term is singultus.[5]
Classification
- hiccups lasting > 48 hours are considered persistent or protracted
- hiccups lasting longer than 1 month are termed intractable
Etiology
- irritation of the vagus nerve (most common)
- pharyngeal branches
- auricular branches
- hair or foreign body
- thoracic branches
- pneumonia
- pleuritis
- thoracic aortic aneurysm
- pericarditis
- thoracic tumors
- myocardial infarction
- GERD with esophagitis
- asthma
- pacemaker lead complications
- abdominal branches
- meningeal branches
- recurrent laryngeal nerve
- diaphragmatic irritation
- disorders that effect the central nervous system
- structural lesions (congenital malformations)
- brain & brainstem neoplasms
- multiple sclerosis
- syringomyelia
- infection
- vascular disease
- seizure
- traumatic brain injury[5]
- metabolic & drug-related etiologies
- alcohol
- uremia
- adverse reaction to pharmacologic agent
- corticosteroid (dexamethosone)
- benzodiazepine (low dose, may be useful for treatment at higher doses)[5]
- Parkinsonian agent
- short-acting barbiturates[5]
- inhaled anesthetics[5]
- donepezil[5]
- ciplastin[5]
- alpha-methyldopa[5]
- hyperglycemia, diabetes mellitus
- electrolyte imbalance (hyponatremia, hypokalemia, hypoocalcemia)
- hypocarbia[5]
- infections
- postoperative etiologies
- general anesthesia
- stimulation of oropharynx or glottis
- traction on viscera
- gastric distention
- neck extension
- psychogenic
- prolonged immobilization[2]
Epidemiology
- hiccups may occur at any age, even in utero, more common in adults, less frequent with advanced age[5]
- no gender predilection except:
- protracted & intractable hiccups more common in men[5]
Pathology
- hiccups appear to serve no purpose in humans[5]
Clinical manifestations
- spasms of the diaphragm muscle
- a single hemidiaphragm may be involved, generally the left[5]
- hiccupd during sleep rule out a psychogenic cause[5]
Laboratory
- arterial blood gas for mechanically-ventilated patients with hiccups
Management
- physical maneuvers
- swallowing
- holding breath
- Valsalva maneuver
- breathing into bag
- carotid sinus massage
- ice water gargle
- ocular compression
- pharmacologic agents
- antipsychotics
- chlorpromazine (Thorazine):
- most common pharmacologic agent used for intractable hiccups (only FDA-approved agent)
- 25 to 50 mg in 500 to 1000 mL of normal saline intravenously, infused slowly TID-QID
- haloperidol (Haldol)
- chlorpromazine (Thorazine):
- local anesthetics - nerve blocks
- lidocaine
- bipivacaine
- muscle relaxants
- metoclopramide (Reglan) 10-20 mg every 6 hours
- amitriptyline (Elavil)
- anticonvulsants
- quinidine
- methylphenidate (Ritalin)
- antipsychotics
- Other modalities
- hypnosis
- psychotherapy
- acupuncture
- direct pharngeal stimulation with a nasal or oral catheter (90% effective)[5]
- direct stimulation of the uvula with a spoon or cotton-tip applicator[5]
- induced emesis or gastric lavage[5]
- phrenic nerve ligation (not first line option)[5]
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 51-53
- ↑ 2.0 2.1 Prescriber's Letter 9(11):66 2002
- ↑ Davis NJ, An experimental study of the hiccup. Brain 1970; 93:851 PMID: https://www.ncbi.nlm.nih.gov/pubmed/5490279
- ↑ Stromberg BV. The hiccup Ear Nose Throat J 1979; 58:354 PMID: https://www.ncbi.nlm.nih.gov/pubmed/387378
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 Sinert RH Fast Five Quiz: Hiccups Medscsape. July 26, 2021 https://reference.medscape.com/viewarticle/955175
- ↑ Wilkes G, Dronen SC Hiccups Medscape. Dec 29, 2017 https://emedicine.medscape.com/article/775746-overview#showall