Hiccups


Background

Diagnosis

Pathophysiology

Differential

Acute: Benign, Self-Limited Chronic: Persistent, Intractable
Gastric distention Central nervous system structural lesions
Alcohol intoxication Vagal or phrenic nerve irritation
Excessive smoking Metabolic: uremia, hyperglycemia
Abrupt change in environmental temperature General anesthesia
Psychogenic Surgical procedures: thoracic, abdominal, prostate and urinary tract, craniotomy
Foreign body in ear touching tympanic membrane (especially hair)

Treatment

  1. Persistent and intractable
  2. In benign cases / underlying cause unlikely, Options listed below:
Physical Maneuvers
Remove foreign body from ear
Swallow a teaspoon of sugar
Sip ice water
Drink water quickly
Drug Initial Dose Maintenance Dose
Chlorpromazine 25–50 mg IV, repeat in 2–4 h if needed 25–50 mg PO three to four times a day
Metoclopramide 10 mgs IV or IM 10–20 mg PO three times a day for 10 d
Haloperidol 2–5 mg IM 1–4 mg PO three times a day
Nifedipine 10–20 mg PO 10–20 mg PO three to four times a day
Valproic acid 15 mg/kg PO 15 mg/kg PO three times a day
Baclofen 10 mg PO 10 mg PO three times a day
Gabapentin (for suspected neurologic cause) 100 mg 100 mg PO three times a day

 

Disposition

  1. If benign: D/C to home; F/U as outpatient
  2. If intractable (>1 mo duration): may require admission for careful work-up, especially if patient is unable to sleep because of hiccups