General Abdomen: Hiccoughs

Hiccoughs (Hiccups/Singultus)

Basics

  • Involuntary Intermittent Spasmodic Contractions of the Diaphragm & Intercostal Muscles
  • Common & Usually Transient (< 48 Hours)
  • Involved Nerves: Vagus, Phrenic & Sympathetics T6-12

Causes

  • Temperature Changes
  • Alcohol & Tobacco
  • Abdominal Distention
  • GERD, Gastritis or Peptic Ulcers
  • Recent Abdominal Surgery
  • Diaphragmatic Hernia

Treatment

  • Initial Tx: Physical Maneuvers (Efficacy Uncertain)
    • Increase Hypercapnia – Hold Breath, Valsalva or Breathe into Bag
    • Nasopharynx Stimulation – Gargle Cold Water, Pull on Tongue or Swallow a Teaspoon of Dry Sugar
    • Vagal Stimulation – Press on Eyeballs
    • Relieve Pressure on Diaphragm – Lean Forward & Pull Knees Forward to Compress Chest
  • Consider Medications if Lasts Over 48 Hours
    • Baclofen
    • Gabapentin
    • Metoclopramide
    • Chlorpromazine
    • PPI if Concerned for GERD