HICCUP

Repeated involuntary spasmodic diaphragmatic and inspiratory intercostal muscle contractions. Hiccups up
to 48 hours are acute, those lasting more than 48 hours are persistent and more than 2 months are intractable.

Causes

  • Gastric distension, GERD, gastritis, diaphragmatic irritation by supraphrenic metastasis, phrenic nerve
    irritation
  • Metabolic: uraemia, hypokalaemia, hypocalcaemia, hyperglycaemia, hypocapnia
  • Infection: oesophageal candidiasis
  • Brain tumour, stroke, stress

Management

  • Most hiccups are short-lived and self-limiting
  • Treat underlying cause

Non-medicine treatment

  • Direct stimulation of the pharynx by swallowing dry bread or other dry food
  • Stimulation of vagus nerve by ingesting crushed ice or valsalva manouvre
  • Rapidly ingest 2 heaped teaspoons of sugar
  • Indirect stimulation of the pharynx
    • C3-5 dermatome stimulation by tapping or rubbing the back of the neck
  • Refer if hiccups persist or are intractable Medicines

For persistent or intractable hiccups use:

  • Metoclopramide 10 mg 8 hourly (if the cause is gastric distension)
  • Or Haloperidol 2–5 mg once a day
  • Or chlorpromazine 25 mg 6 hourly