Name
HICCUPS
DESCRIPTION
DETAIL
CAUSES & DIFFERENTIAL DIAGNOSIS: 1. OCCASIONAL HICCUPS - GASTRIC DISTENSION AFTER RAPID INGESTION OF FOOD , ALCOHOL O R AIR - EXCITEMENT - SUDDEN CHANGE IN TEMP EITHER OF ENVIRONMENT OR OF STOMACH INDUCED BY THE VERY HOT OR COLD MEAL - SPICY FOOD PERSISTANT HICCUPS 1. INTRATHORACIC CAUSES - MALIGNANT LYMPHADENOPATHY DUE TO TUMORS OF THE LUNG , OESOPHAGUS OR DUE TO A LYMPHOMA - AORTIC ANEURYSM - MEDIASTINAL SURGERY OR MEDIASTINITIS - MYOCARDIAL INFARCTION - PERICARDITIS - DIAPHRAGMATIC PLEURISY - PNEUMONIA - EMPYEMA 2. INTRA-ABDOMINAL CAUSES - DIAPHRAGMATIC IRRITATION DUE TO - DIAPHRAGMATIC HERNIA - SUBPHRENIC ABSCESS - PERITONITIS - PANCREATITIS - LIVER METASTASIS - LIVER ABSCESS - SPLENIC INFARCT - CARCINOMA OF STOMACH - CARCINOMA OF COLON & UTERUS ( RARE ) - INTESTINAL OBSTRUCTION - AFTER ABDOMINAL OR PELVIC OPERATIONS - ACUTE POSTOPERATIVE DILATATION OF STOMACH 3. CENTRAL - EPIDEMIC ENCEPHALITIS - LESIONS OF MEDULLA - INTRACRANIAL TUMORS - INTRACRANIAL HAEMORRHAGE - BRAIN ABSCESS - MENINGITIS ( ESPECIALLY BASAL ) - UREMIC - ACUTE HIGH FEVER - HYSTERICAL - DRUGS LIKE BENZODIAZEPINES & SHORT ACTING BARBITURATES IMAGING Fluoroscopy is useful to determine if one hemidiaphragm is dominant
TYPENOTES
GENERAL MEASURES: . Treat any specific underlying cause when identified. . Dilate esophageal stricture or obstruction . Remove hair or foreign body from ear canal . Angostura bitters for alcohol induced hiccups . Catheter stimulation of pharynx for operative and postoperative hiccups . Antifungal treatment for Candida esophagitis . Correct electrolyte imbalance . Simple home remedies . Swallowing a spoonful of sugar . Sucking on a hard candy or swallowing peanut butter . Holding breath and increasing pressure on diaphragm (Valsalva maneuver) . Tongue traction . Lifting the uvula with a cold spoon . Drinking from the far side of a glass . Inducing fright . Smelling salts . Rebreathing into a paper (not plastic) bag . Sipping ice water . Medical measures . Relief of gastric distention (gastric lavage, nasogastric aspiration, induced vomiting) . Counterirritation of the vagus nerve (supraorbital pressure, carotid sinus massage, digital rectal massage), to be used with caution . Respiratory center stimulants (breathing 5% carbon dioxide) . Phrenic nerve block or electrical stimulation of dominant hemidiaphragm . Psychiatric (hypnosis, behavioral modifi cation) . Miscellaneous (cardioversion, acupuncture) SURGICAL MEASURES Phrenic nerve crush or transection ACTIVITY As tolerated DIET Avoid gastric distension from overeating, carbonated beverages, aerophagia DRUG(S) OF CHOICE Possible drug remedies: β’ Baclofen, a GABA analog, 5-10 mg tid (best choice) β’ Chlorpromazine 25-50 mg IV β’ Haloperidol 2-12 mg IM β’ Phenytoin 200 mg IV then 100 mg qid β’ Metoclopramide 5-10 mg qid β’ Nifedipine 10-20 mg qd-tid β’ Amitriptyline 10 mg tid β’ Lidocaine 1.5 mg/kg IV infusion followed by 0.75 mg/kg on subsequent days β’ Gabapentin (Neurontin) up to 1800 mg/d in divided doses ALTERNATIVE DRUGS β’ Amantadine, carbidopa-levodopa in Parkinson disease β’ Steroid replacement in Addison disease β’ Antifungal agent in Candida esophagitis β’ Ondansetron in carcinomatosis with vomiting β’ Nefopam (a nonopioid analgesic with anti-shivering properties related to antihistamines and antiparkinsonian drugs) is available outside the US in both IV and oral formulations PREVENTION/AVOIDANCE β’ Correct underlying cause β’ Maintenance drug therapy (e.g., baclofen 5-10 mg tid; phenytoin 100 mg qid; valproic acid 15 mg/kg undivided doses; nifedipine 10-20 mg qd-tid; metoclopramide 10 mg qid) POSSIBLE COMPLICATIONS β’ Inability to eat β’ Weight loss β’ Exhaustion, debility β’ Insomnia β’ Cardiac arrhythmias β’ Wound dehiscence β’ Death (rare) EXPECTED COURSE/PROGNOSIS β’ Hiccups often cease during sleep β’ Most acute benign hiccups resolve with home remedies or spontaneously β’ Intractable hiccups may last for years and decades β’ Hiccups have persisted despite bilateral phrenic nerve transection
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD UREA, ULTRA SOUND WHOLE ABDOMEN - MALE, COMPLETE BLOOD COUNT, ECG, CSF EXAMINATION, CT SCAN
[HICCUPS]