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