A. Introduction. A hiccough is an inspiratory sound caused by the abrupt closure of the glottis in the setting of rhythmic spasm of the diaphragm and respiratory muscles.
B. Causes of Hiccoughs. Hiccoughs may be caused by a wide variety of conditions that share one thing in common—they involve the reflex arc shown in Figure 84.1. Causes can be classified as peripheral (i.e., involving the vagus or phrenic nerves and/or structures adjacent to the diaphragm) or central.
MNEMONIC: Common Causes of Hiccoughs (Also Known as Singultus) (“Singultus”)
Surgery (following abdominal, thoracic, or neck surgery)
Infection of structures adjacent to the diaphragm (e.g., lower lobe pneumonia, subphrenic abscess, peritonitis)
Nervous system disorders (e.g., stroke, meningitis, brain tumor, multiple sclerosis)
Gastric distention (a very common cause)
Low serum calcium, sodium, or potassium
Tumor of the pancreas
Steroids and other drugs (e.g., alcohol, benzodiazepines, barbiturates)
C. Treatment. Treating the underlying disorder is the best course of action.
a. Several benign strategies to relieve hiccoughs have been anecdotally successful, though limited evidence is available to support these interventions (e.g., drinking water, swallowing saliva).
b. Pharmacologic therapy (e.g., chlorpromazine, metoclopramide, or baclofen) may be used if benign strategies fail.
c. Testing or imaging are rarely indicated for hiccoughs unless clinical concern of a systemic cause of malignancy exist.
Suggested Further Readings
Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog 2010;57:150–6; quiz 7.Find this resource:
Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012;18:123–30.Find this resource:
Goldstein R. Practice tips. Simple method for curing hiccups. Can Fam Physician 1999;45:1459. (Classic Article.)Find this resource:
Launois S, Bizec JL, Whitelaw WA, Cabane J, Derenne JP. Hiccup in adults: an overview. Eur Respir J 1993;6:563–75. (Classic Article.)Find this resource:
Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013.Find this resource:
Smith HS, Busracamwongs A. Management of hiccups in the palliative care population. Am J Hospice Palliat Med 2003;20:149–54.Find this resource: