Title: Fast Fact and Concept #81: Hiccups
Author(s): Chad Farmer, MD
Hiccups (singultus) are distressing to patients and families; when chronic, they diminish quality of life. A hiccup is an involuntary reflex involving the respiratory muscles of the chest and diaphragm, mediated by the phrenic and vagus nerves and a central (brainstem) reflex center. A single episode can last for a few seconds to as long as several days; if lasting longer than 48 hours they are termed persistent; if longer than one month, intractable. Etiologies range from stress/excitement to cancer, myocardial infarction, gastric distension, liver disease, uremia, IV steroids, CNS lesions and idiopathic. Irritation of the vagus nerve or diaphragm are common pathophysiologic mechanisms.Management
A thorough history, review of medications, focused review of systems and physical exam may help guide initial choice of treatment. Many drug and non-drug treatments have been used, but there is little evidence of any one superior approach to management; virtually all current data is anecdotal. Once hiccups have gone beyond a time limited annoyance, deciding on therapeutic intervention should be based on a thorough clinical assessment and, if possible, treatment directed at the underlying cause. The patient's prognosis, current level of function and potential adverse effects from any proposed treatment should be considered.
There are many well known, time honored home remedies: gargling with water, biting a lemon, swallowing sugar, or producing a fright response. Other approaches are directed at a) vagal stimulation: carotid massage or valsalva maneuver; b) interruption of phrenic nerve transmission via rubbing over the 5th cervical vertebrae; c) interrupting the respiratory cycle through sneezing, coughing, breath holding, hyperventilation, or breathing into a paper bag. Other interventions, acupuncture diaphragmatic pacing electrodes, or surgical ablation of the reflex arc, can be considered when other treatments fail.References
Kolodzik PW, Eilers, MA: Hiccups (singultus): Review and approach to management. Ann Emerg Med 1991; 20:565-573.
Lewis J. Hiccups: Causes and cures. J Clin Gastro 1985; 7:539-552.
Rousseau, P. Hiccups. Southern Med J 1995;2:175-181.
Bondi, N, Bettelli, A. Treatment of hiccup by acupuncture in patients under anesthesia and in conscious patients. Minerva Med 1981; 72:2231-2234.
Treatment of intractable hiccup with baclofen: Results of a double-blind, randomized, controlled, cross-over study. A J Gastro 1992;87:1789-91.
Physicians Desk Reference, 2002
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #81 Hiccups. Farmer, C. January 2003. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
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Creation Date: 1/2003
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
ACGME Competencies: Medical Knowledge, Patient Care
Keyword(s): Gastrointestinal, Neurologic
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