Hiccups

Revision as of 14:45, 9 September 2015 by Rossdonaldson1 (talk | contribs) (Differential Diagnosis)

Background

  • Usually initiated by gastric distention from food, carbonated beverage, or air
  • Also known as Singultus

Clinical Features

  • Hiccups

Differential Diagnosis

Hiccups

  • Central nervous system disorders
    • Vascular
      • Ischemic/hemorrhagic stroke, AV malformations, temporal arteritis
    • Infections
      • Encephalitis, meningitis, brain abscess, neurosyphillis, subphrenic abscess
    • Structural
      • Head trauma, intracranial neoplasms, 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
  • Gastrointestinal disorders
    • Gastric distention, gastritis, peptic ulcer disease, pancreatitis, pancreatic cancer, gastric carcinoma, abdominal abscesses, gallbladder disease, inflammatory bowel disease, hepatitis, aerophagia, esophagael distention, esophagitis, bowel obstruction
  • Thoracic disorders
    • Enlarged lymph nodes secondary to infection or neoplasm*, pneumonia, empyema, bronchitis, asthma, pleuritis, aortic aneurysm, mediastinitis, mediastinal tumors, chest trauma, pulmonary embolism
  • Cardiovascular disorders
    • Myocardial infarction, pericarditis
  • Toxic-metabolic
    • Alcohol
    • 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 barbituates
    • Chemotherapeutic agents (eg, carboplatin)
    • Dexamethasone
    • Diazepam
  • Psychogenic
    • Anorexia nervosa
    • Conversion reaction
    • Excitement
    • Malingering
    • Schizophrenia
    • Stress

Diagnostic Evaluation

  • Clinical diagnosis
  • Consider auditory canal exam (foreign body against TM can trigger hiccups)
  • 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