Hiccups is a common and mostly harmless condition.
Most hiccups are benign and self-limited, rarely requiring medical attention. However, various organic and psychogenic causes can lead to persistent, intractable hiccups that can last for years.
Persistent intractable hiccups can lead to malnutrition, weight loss, dehydration, fatigue, depression, insomnia, and reduced quality of life.
Various therapies have been described, from nonprescription remedies to mechanical stimulation of the involved anatomic structures.
Unfortunately, most of the evidence for treatments of hiccups come from uncontrolled observational trials or case-control series or reports. Valid randomized trials are therefore needed to thoroughly investigate the effectiveness of therapies for this indication.
A hiccup is an abrupt contraction of the inspiratory muscles that repeats several times per minute. The resultant sudden rush of air into the lungs causes the glottis to close, creating a distinctive "hic" sound.
History and exam
Key diagnostic factors
- hic" sound
Other diagnostic factors
- duration <1 hour (benign hiccups)
- duration >1 hour (persistent intractable hiccups)
- persistence during sleep
- associated features of underlying cause
- weight loss and malnutrition
- aerophagia, temperature changes, and emotional states
- diaphragmatic and phrenic nerve irritation
- vagus nerve irritation
- central nervous system disorders
- metabolic/electrolyte abnormalities
- psychogenic disorders
- sedation or anesthesia
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum electrolytes
- CRP and erythrocyte sedimentation rate
- liver function tests
- gamma glutamyl transpeptidase (gamma-GT)
- serum amylase
- toxicology screen
- arterial blood gas
- pulmonary function tests
- CT abdomen
- endoscopy of the upper gastrointestinal tract
- CT or MRI head
- lumbar puncture
persistent intractable hiccups
Peter Kranke, MD, PhD, MBA
Professor of Anaesthesia
Department of Anaesthesia and Critical Care
University of Würzburg Hospital
PK is an author of a reference cited in this topic.
Yvonne Jelting, MD
Assistant Physician and Study Subinvestigator
Department of Anesthesia and Critical Care
University Hospital of Wuerzburg
YJ declares that she has no competing interests.
Professor Peter Kranke and Dr Yvonne Jelting would like to gratefully acknowledge Dr Thomas M. Metterlein, a previous contributor to this topic. TMM declares that he has no competing interests.
Andy Smith, BM, BS, MRCP, FRCA
Consultant Anaesthetist and Associate Director of Research and Development
Lancaster Patient Safety Research Unit
Royal Lancaster Infirmary
AS declares that he has no competing interests.
Stefan K. Burgdorf, MD
Department of Surgical Gastroenterology
University of Copenhagen
SKB declares that he has no competing interests.
Howard Smith, MD, FACP
Academic Director of Pain Management
Associate Professor of Anesthesiology
Department of Anesthesiology
Albany Medical College
HS is an author of a reference cited in this topic.
Use of this content is subject to our disclaimer