Difference between revisions of "Hiccups"

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==Background==
 
==Background==
 
*Usually initiated by gastric distention from food, carbonated beverage, or air
 
*Usually initiated by gastric distention from food, carbonated beverage, or air
*Also known as Singultus  
+
*Also known as Singultus
  
==Workup==
+
===Definitions===
*Auditory canal exam (foreign body against TM can trigger hiccups)
+
*Hiccup bout: <48 hours
*CXR
+
*Persistent hiccups: 48 hours to 1 month
 +
*Intractable hiccups: >1 month
  
==Treatment ==
+
==Clinical Features==
#Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
+
*Hiccups
##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
 
  
==Source==
+
==Differential Diagnosis==
Tintinalli
+
===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
 +
***[[thyroid disease|Goiter]]
 +
***[[Pharyngitis]]
 +
***[[Laryngitis]]
 +
***Hair or foreign body irritation of tympanic membrane
 +
***Neck cyst or other tumor
 +
*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]]
 +
**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
 +
**[[Mediastinitis]]
 +
**Mediastinal tumors
 +
**[[Chest trauma]]
 +
**[[Pulmonary embolism ]]
 +
*Cardiovascular disorders
 +
**[[Myocardial infarction]]
 +
**[[Pericarditis]]
 +
*Toxic-metabolic
 +
**[[Alcohol intoxication]]
 +
**[[Diabetes mellitus]]
 +
**[[Herpes zoster]]
 +
**[[Hypocalcemia]]
 +
**[[Hypocapnia]]
 +
**[[Hyponatremia]]
 +
**[[Influenza]]
 +
**[[Malaria]]
 +
**[[Tuberculosis]]
 +
**[[Uremia]]
 +
*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 [[ear foreign body|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
 +
 
 +
==Disposition==
 +
*Discharge for uncomplicated hiccups
 +
 
 +
==See Also==
 +
 
 +
==References==
 +
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]
 +
[[category:Symptoms]]

Latest revision as of 18:00, 23 January 2020

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

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

Disposition

  • Discharge for uncomplicated hiccups

See Also

References