Hiccups: Difference between revisions
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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 (PPI). 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== | ||
Revision as of 15:50, 26 August 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
- Central nervous system disorders
- Vascular
- Ischemic/hemorrhagic stroke
- AV malformations
- Temporal arteritis
- Infections
- Encephalitis
- Meningitis
- Brain abscess
- Neurosyphilis
- Subphrenic abscess
- Structural
- Head trauma
- Intracranial neoplasm
- Brainstem neoplasms
- Multiple sclerosis
- Syringomyelia
- Hydrocephalus
- Vagus and phrenic nerve irritation
- Goiter
- Pharyngitis
- Laryngitis
- Hair or foreign body irritation of tympanic membrane
- Neck cyst or other tumor
- Vascular
- Gastrointestinal disorders
- Gastric distention
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Pancreatic cancer
- Gastric carcinoma
- Abdominal abscesses
- Gallbladder disease
- Inflammatory bowel disease
- Hepatitis
- Aerophagia
- Esophageal distention
- Esophagitis
- Bowel obstruction
- Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm
- Pneumonia
- Empyema
- Bronchitis
- Asthma
- Pleuritis
- Aortic dissection
- Mediastinitis
- Mediastinal tumors
- Chest trauma
- Pulmonary embolism
- Cardiovascular disorders
- Toxic-metabolic
- Postoperative
- General anesthesia
- Intubation (stimulation of glottis)
- Neck extension (stretching phrenic nerve roots)
- Gastric distention
- Traction on viscera
- Drugs
- Alpha methyldopa
- Short-acting barbiturates
- Chemotherapeutic agents (eg, carboplatin)
- Dexamethasone
- Diazepam
- Psychogenic
- Anorexia nervosa
- Conversion reaction
- Excitement
- Malingering
- Schizophrenia
- Stress
Evaluation
- Clinical diagnosis
- Consider auditory canal exam (foreign body against TM can trigger hiccups)
- Consider Hyponatremia and Hypocalcemia
- Consider CXR
Management
- Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
- Remove foreign body from ear
- Swallow teaspoon of sugar
- Sip ice water
- Drink water quickly
- Meds
- Chlorpromazine 25–50mg IV; 25–50mg PO TID
- Metoclopramide 10mg IV or IM; 10–20mg PO TID x 10d
- Initiating pharmacologic treatment with a proton pump inhibitor (PPI). Alternative first-line agents include baclofen, gabapentin, and metoclopramide[1]
Disposition
- Discharge for uncomplicated hiccups