Summary
Definition
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
Risk factors
- aerophagia, temperature changes, and emotional states
- diaphragmatic and phrenic nerve irritation
- vagus nerve irritation
- central nervous system disorders
- metabolic/electrolyte abnormalities
- toxins/drugs
- psychogenic disorders
- sedation or anesthesia
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- CBC
- serum electrolytes
- BUN
- CRP and erythrocyte sedimentation rate
- liver function tests
- gamma glutamyl transpeptidase (gamma-GT)
- serum amylase
- toxicology screen
- arterial blood gas
- ECG
- CXR
- pulmonary function tests
- CT abdomen
- endoscopy of the upper gastrointestinal tract
- CT or MRI head
- lumbar puncture
- otoscopy
- pharyngoscopy
Treatment algorithm
benign hiccups
persistent intractable hiccups
Contributors
Authors
Peter Kranke, MD, PhD, MBA
Professor of Anaesthesia
Department of Anaesthesia and Critical Care
University of Würzburg Hospital
Würzburg
Germany
Disclosures
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
Wuerzburg
Germany
Disclosures
YJ declares that she has no competing interests.
Acknowledgements
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.
Peer reviewers
Andy Smith, BM, BS, MRCP, FRCA
Consultant Anaesthetist and Associate Director of Research and Development
Director
Lancaster Patient Safety Research Unit
Royal Lancaster Infirmary
Lancaster
UK
Disclosures
AS declares that he has no competing interests.
Stefan K. Burgdorf, MD
Registrar
Department of Surgical Gastroenterology
Herlev Hospital
University of Copenhagen
Denmark
Disclosures
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
Albany
NY
Disclosures
HS is an author of a reference cited in this topic.
Differentials
- Gasping
- Burping
More Differentials
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer