II. Pathophysiology

  1. Locally mediated via diaphragmatic irritation
  2. Sudden involuntary diaphragmatic contraction
    1. Inspiration interrupted by glottic closure
    2. Characteristic sharp sound emitted
  3. Peripheral Nerves involved
    1. Phrenic Nerve
    2. Vagus Nerve
    3. Reflex arc
      1. Afferent Limb: Sympathetic chain (T6-T12)
      2. Efferent Limb: Phrenic nerve

III. Causes: Transient Hiccups (gastric distention)

  1. Excessive laughter or tickling
  2. Aerophagia
  3. Tobacco Abuse
  4. Overindulgence in food or Alcohol
  5. Gastroesophageal Reflux
  6. Change in gastric Temperature
    1. Movement into hot or cold environment
    2. Ingestion of hot or cold foods

IV. Causes: Intractable Hiccups (>48 hours)

  1. Reflex Stimulation
    1. Alcohol Abuse
    2. Anxiety Disorder
    3. Transient Hiccup causes above
  2. Neurologic disorders
    1. Encephalitis
    2. Meningitis
    3. Vertebrobasilar ischemia
    4. Intracranial Hemorrhage
    5. Intracranial Tumor
    6. Uremia
    7. Dementia
    8. Tabes Dorsalis
    9. Cardiac Pacemaker stimulating diaphragm
  3. Mediastinal disorders
    1. Aortic Dissection
    2. Phrenic nerve Trauma
    3. Mediastinal Lymph Node involvement
      1. Mycobacterium tuberculosis
      2. Malignant neoplasm
      3. Pulmonary fibrosis
      4. Sarcoidosis
    4. Bronchial obstruction
    5. Adherent Pericardium
    6. Cardiomegaly
    7. Myocardial Infarction
    8. Esophageal obstruction
    9. Pneumonia with Pleural irritation
  4. Abdominal disorders
    1. Diaphragmatic Hernia of Stomach
    2. Gastroesophageal Reflux
    3. Subphrenic abscess
    4. Subphrenic peritonitis
    5. Liver disease
      1. Liver tumor or mass
      2. Liver Abscess
    6. Stomach Cancer
    7. Splenic infarction
    8. Acute Intestinal Obstruction or Small Bowel Obstruction
    9. Acute hemorrhagic Pancreatitis
    10. Post-operative abdominal surgery
  5. Medications
    1. Corticosteroids
    2. Benzodiazepines
    3. Chemotherapy
    4. Dopamine Agonists
  6. Miscellaneous
    1. Tympanic Membrane foreign body

V. Symptoms

  1. Hiccups occur 2-3 times per minute

VI. Management: Transient Hiccups

  1. Folk Remedies
    1. Breath-holding
    2. Tongue traction
    3. Breathing into a paper bag
    4. Suddenly frightened
    5. Gargling ice water
    6. Drinking water from wrong side glass and occlude ears
  2. Stimulate pharyngeal mucosa
    1. Swallow teaspoon vinegar, pickle juice or dry granulated sugar
  3. Stimulate Gag Reflex with Tongue depressor
    1. Avoid if recent food intake (aspiration risk)

VII. Management: Intractable Hiccups

  1. Central acting medications
    1. First-line central agents
      1. Chlorpromazine (Thorazine)
        1. Best studied of all agents used for Hiccups
        2. Initial: 50 mg IV bolus (monitor for Hypotension, QT Prolongation)
        3. Maintenance if effective: oral dose for 10 days
        4. Friedgood (1955) J Am Med Assoc 157(4): 309-10 [PubMed]
      2. Gabapentin (Neurontin) for up to 7-10 days
      3. Baclofen for up to 7-10 days
    2. Other agents
      1. Diphenylhydantoin
      2. Haloperidol 5 mg orally three times daily
        1. Ives (1985) Am J Psychiatry 142(11): 1368-9 [PubMed]
      3. Orphenadrine 60 mg IM or 100 mg PO
      4. Ketamine 0.1 to 0.2 mg/kg IV
      5. Carbamazepine 200 mg PO qid
  2. Peripheral acting medications
    1. First-line peripheral agents
      1. Metoclopramide (Reglan) 10 mg PO qid (most efficacious)
      2. Wang (2014) Intern Med J 44(12a): 1205-9 [PubMed]
    2. Other agents
      1. Quinidine 200 mg PO qid
      2. Atropine 1 mg IV
      3. Edrophonium chloride 10 mg IV
      4. Amphetamine 30 mg PO qd for 1 week
      5. Amyl nitrite

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Related Studies

Ontology: Hiccup (C0019521)

Definition (MSHCZE) Náhlé, prudké a mimovolní stahy bránice vyvolané drážděním bráničního nervu nebo podrážděním mozkových center. Stahy bránice, která je hlavním dýchacím svalem, vedou k prudkému nasávání vzduchu do plic a ten při průchodu hrtanem způsobí prudké uzavření epiglottis, čímž vzniká typický zvuk. Častými provokujícími faktory jsou chladný nápoj s obsahem oxidu uhličitého, alkohol, přeplnění žaludku pivo. Vzácněji vyvolávají s. některé nemoci mezihrudí, nádory, brániční kýla, plicní onemocnění apod. Při dlouho trvající škytavce lze na krku provést obstřik, popř. i přetětí bráničního nervu nerv později regeneruje. (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (MEDLINEPLUS)

A hiccup is an unintentional movement of the diaphragm, the muscle at the base of the lungs. It's followed by quick closing of the vocal cords, which produces the "hic" sound you make. There are a large number of causes, including large meals, alcohol, or hot and spicy foods. Hiccups may also start and stop for no obvious reason.

There is no sure way to stop hiccups. You can try

  • Breathing into a paper bag
  • Drinking or sipping a glass of cold water
  • Holding your breath

Hiccups aren't usually serious. Contact your health care provider if they last for more than a few days.

Definition (NCI_CTCAE) A disorder characterized by repeated gulp sounds that result from an involuntary opening and closing of the glottis. This is attributed to a spasm of the diaphragm.
Definition (NCI) A diaphragmatic spasm causing a sudden inhalation which is interrupted by a spasmodic closure of the glottis, producing a noise.(On-line Medical Dictionary)
Definition (MSH) A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound.
Concepts Finding (T033)
MSH D006606
ICD9 786.8
ICD10 R06.6
SnomedCT 207105009, 65958008, 139211009, 161952001, 301249005, 161955004, 139208008, 158416003
English Hiccup, HICCOUGH, HICCUP, Hiccough, SINGULTUS, Hiccough NOS, [D]Hiccough (context-dependent category), [D]Hiccough, hiccough, hiccups (symptom), hiccups, hiccups (physical finding), hiccups were heard, Singultation, Singultous, Hiccup [Disease/Finding], Hiccoughs/hiccups, hiccoughs, hiccoughing, hiccup, hiccuping, Hiccough (& [symptom]) (finding), Hiccough symptom, Hiccough (& [symptom]), [D]Hiccough (situation), Hiccough NOS (finding), Finding of hiccoughs (finding), HICCUPS, Singultus, Hiccups, Hiccoughs, Observation of hiccoughs, Finding of hiccoughs, Hiccoughs (finding), singultus, hiccoughs/hiccups
French HOQUET, Hoquets, Hoquet
Portuguese SOLUCO, Soluçante, SOLUCAR, SOLUCOS, Soluços, Soluço
Spanish HIPO, Singulto, [D]hipo (categoría dependiente del contexto), [D]hipo, [D]hipo (situación), hipo, SAI (hallazgo), hipo, SAI, hallazgo en el hipo (hallazgo), hallazgo en el hipo, Hiccough NOS, hipo (hallazgo), hipo, Hipo
Italian Singhiozzi, Singhiozzo
Dutch singultus, hik, Hikken
Swedish Hicka
Japanese シャックリ, 吃逆, しゃっくり, シャックリ
Czech škytavka, Škytnutí, Škytající, Škytavka, Singultace, Singultus, Škytavky, singultus
Finnish Nikotus
Korean 딸꾹질
Polish Czkawka
Hungarian Csuklás, Singultus
Norwegian Hikke