Summary
Definition
History and exam
Key diagnostic factors
- "hic" sound
Other diagnostic factors
- duration <48 hours (typically benign hiccups)
- duration >48 hours (chronic 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 tests
1st tests to order
- clinical diagnosis
Tests to consider
- CBC
- serum electrolytes
- BUN
- C-reactive protein and erythrocyte sedimentation rate
- liver function tests
- gamma glutamyl transpeptidase (gamma-GT)
- serum amylase
- toxicology screen
- arterial blood gas
- ECG
- chest x-ray
- pulmonary function tests
- CT abdomen
- endoscopy of the upper gastrointestinal tract
- CT or MRI head
- lumbar puncture
- otoscopy
- pharyngoscopy
Treatment algorithm
benign hiccups
chronic hiccups
Contributors
Authors
Aminah Jatoi, MD
Professor of Oncology
Department of Oncology
Mayo Clinic
Rochester
MN
Disclosures
AJ has received a grant review for Pfizer (money is paid to her institution) and research funding from AstraZeneca. AJ is on an advisory board for Meter Health and Novartis. AJ is an author of one reference cited in this topic.
Acknowledgements
Professor Aminah Jatoi would like to gratefully acknowledge Professor Peter Kranke, Dr Yvonne Jelting, and Dr Thomas M. Metterlein, previous contributors to this topic.
Disclosures
PK is an author of a reference cited in this topic. YJ and TMM declare that they have 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Lewis JH. Hiccups: causes and cures. J Clin Gastroenterol. 1985 Dec;7(6):539-52. Abstract
Wagner MS, Stapczynski JS. Persistent hiccups. Ann Emerg Med. 1982 Jan;11(1):24-6. Abstract
Rousseau P. Hiccups. South Med J. 1995 Feb;88(2):175-81. Abstract
Moretto EN, Wee B, Wiffen PJ, et al. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD008768.Full text Abstract
Zhu LL, Wang WX, Guo XG. Acupuncture for hiccups after stroke: a systematic review. Chin J Evid Based Med. 2011;11:325-8.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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