intractable hiccups?

9 Oct

SOME INTERESTING DEFINITIONS:

involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles.

Muscle contraction results in a sudden inspiration and ends with abrupt closure of the glottis, thereby generating the characteristic ‘hic’ sound.

often occur with a frequency of 4 to 60 per minute

The medical term for hiccups (also referred to as ‘hiccoughs’) is singultus, derived from the Latin singult, which means ‘a gasp’ or ‘a sob.’

 

SOME PHYSIOLOGY:

exact mechanism provoking hiccups remains unknown.

involve unilateral contraction of the left hemidiaphragm in ~80%

pathways involve phrenic and vagus nerves

 

COMMON CAUSES:

  • gastric distention from overeating,
  • carbonated beverages,
  • swallowing with chewing gum or smoking
  • gastric insufflation during endoscopy
  • sudden changes in ambient or gastrointestinal temperature
  • excessive alcohol ingestion.
  • Sudden excitement or other emotional stress

LESS COMMON CAUSES:

the list of less common, but potential causes is broad, e.g.

  • CNS disorders
  • vagus or phrenic nerve irritation
  • GI disorders
  • thoracic disorders
  • cardiac
  • tox
  • post-op
  • psychogenic

Message: if they have other odd or associated symptoms, consider chasing them to a broader differential.

 

POSSIBLE TREATMENTS:

Non-medication (a fun list, with mostly little downside):

Breath holding
Valsalva maneuver
Breathing into bag
Ice water gargles
Swallowing granulated sugar, hard bread, or peanut butter
Drinking from opposite side of glass
Catheter or cotton swab stimulation of nasooropharynx
Forceable traction on the tongue
Biting on a lemon
Fright
Noxious odors (inhaling ammonia)
Pressing on the eyeballs
Pulling knees to chest or leaning forward to compress the chest

 

Medication options:

first suggestions involve chlorpromazine, reglan, or baclofen.

cyclobenzaprine, haldol are also among the more readily ED available meds on the list.  often these meds are not expected to work immediately.

 

References: uptodate.com; picture

 

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