Hiccups

Basics

Sudden, involuntary contraction of the diaphragm (usually unilateral) and other inspiratory muscles terminated by abrupt closure of the glottis
Medical terminology: Singultus
Usually occur with a frequency of 4–60/min
Occurs as a result of stimulation of the hiccup reflex arc:
- Irritation of the vagus and phrenic nerves
- The “hiccup center” is located in the upper spinal cord or brainstem
Classification:
- Hiccup bout: <48 hr
- Persistent hiccups: 48 hr–1 mo
- Intractable hiccups: >1 mo
Male > female (4:1)

GI:
- Gastric distention, overeating, eating too fast
- Esophageal: Gastroesophageal reflux, achalasia, candida esophagitis, cancer
- Gastric: Ulcers, cancer
- Hepatic: Hepatitis, hepatoma
- Pancreatic: Pancreatitis, pseudocyst, cancer
- Bowel obstruction
- Inflammatory bowel disease
- Cholelithiasis, cholecystitis
- Appendicitis
- Abdominal aortic aneurysm
- Postoperative, abdominal procedure
Diaphragmatic irritation:
- Hiatal hernia
- Intra-abdominal mass
- Pericarditis
- Eventration
- Splenomegaly, hepatomegaly
- Peritonitis
CNS:
- Vascular lesions: Ischemic/hemorrhagic stroke, head trauma, arteriovenous malformations
- Infectious: Encephalitis, meningitis, abscess
- Structural: Cancer, Parkinson disease, multiple sclerosis, hydrocephalus
- Ventriculoperitoneal shunt
Thoracic:
- Infectious: Pneumonia, TB
- Cardiac: MI, pericarditis
- Aortic aneurysm
- Cancer
- Mediastinal lymphadenopathy
Head and neck:
- Otic foreign body irritating the tympanic membrane
- Pharyngitis
- Laryngitis
- Goiter
- Retropharyngeal/peritonsillar abscess
- Neck mass
Metabolic:
- Uremia
- Hyponatremia
- Hypocalcemia
- Gout
- DM
Toxic/drug induced:
- Alcohol
- Tobacco
- α-methyldopa
- Benzodiazepines
- Steroids
- Barbiturates
- Narcotics
- Chemotherapeutic agents
- Antibiotics
- General anesthesia
Psychogenic causes:
- Stress/excitement
- Grief
- Malingering
- Conversion disorder
Idiopathic

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