Hiccups

Overview
Hiccups are sudden, involuntary contractions of the diaphragm — the muscle that separates the chest from the abdomen and plays an important role in breathing. Each contraction is followed by a sudden closure of the vocal cords, which produces the characteristic “hic” sound. In most cases, hiccups are harmless and temporary, lasting only a few minutes to a few hours. However, persistent hiccups (lasting more than 48 hours) or intractable hiccups (lasting more than a month) may indicate an underlying medical problem and require medical evaluation.

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Causes

• Common and benign triggers

  • Eating too quickly or overeating

  • Drinking carbonated beverages or alcohol

  • Sudden changes in stomach temperature (e.g., hot then cold drinks)

  • Swallowing air while chewing gum or sucking on candy

  • Emotional stress or excitement

• Medical conditions (more serious)

  • Gastrointestinal: GERD, gastritis, peptic ulcer disease, hiatal hernia

  • Nervous system disorders: stroke, brain tumor, encephalitis, meningitis, multiple sclerosis

  • Respiratory conditions: pneumonia, pleurisy, asthma, mediastinal tumors

  • Metabolic and systemic: diabetes, kidney failure, electrolyte imbalance

  • Drugs: steroids, benzodiazepines, opioids, chemotherapy drugs

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Symptoms

• Repeated involuntary “hic” sounds

• Mild chest or abdominal tightening during diaphragm contraction

• Disruption of eating, sleeping, or speaking if prolonged

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Diagnosis

• Short-term hiccups: Usually no tests are needed.

• Persistent or intractable hiccups:

  • Detailed history (medications, alcohol use, recent illness)

  • Physical examination

  • Blood tests (electrolytes, kidney function, liver function)

  • Imaging: Chest X-ray, CT, or MRI (if neurological or thoracic cause suspected)

  • Endoscopy (if gastrointestinal cause suspected)

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Treatment

• For temporary hiccups (self-care):

  • Holding breath for short periods

  • Drinking a glass of cold water quickly

  • Gargling with water

  • Swallowing a teaspoon of sugar

  • Pulling on the tongue or gently stimulating the back of the throat

• For persistent hiccups (medical treatment):

  • Chlorpromazine (first-line; antipsychotic, also effective against hiccups)

    • Dose: 25–50 mg orally every 6–8 hours (or IV/IM in hospital settings)

  • Metoclopramide (dopamine antagonist, enhances gastric emptying)

    • Dose: 10 mg orally or IV every 6–8 hours

  • Baclofen (GABA agonist, muscle relaxant)

    • Dose: 5–10 mg orally three times daily

  • Gabapentin (antiepileptic, reduces diaphragmatic excitability)

    • Dose: 300 mg orally once daily, may increase to three times daily

• Other measures (for refractory cases):

  • Phrenic nerve block or vagus nerve stimulation

  • Treatment of underlying cause (e.g., proton pump inhibitors for GERD)

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When to seek medical help

• Hiccups lasting more than 48 hours

• Severe disruption of eating, sleeping, or daily activities

• Associated with chest pain, severe abdominal pain, neurological symptoms, or vomiting blood

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Precautions

• Avoid overeating, alcohol, and carbonated beverages if prone to hiccups

• Manage underlying conditions like GERD or diabetes

• Monitor medications that can trigger hiccups (consult doctor before stopping)

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Drug Interactions

• Chlorpromazine: interacts with CNS depressants (alcohol, opioids, sedatives), increasing risk of sedation and respiratory depression

• Metoclopramide: interacts with antipsychotics (risk of extrapyramidal symptoms), SSRIs (risk of serotonin syndrome)

• Baclofen: interacts with other CNS depressants (benzodiazepines, alcohol) causing excessive drowsiness

• Gabapentin: interacts with antacids containing magnesium/aluminum (reduced absorption), and enhances sedative effects with opioids or alcohol