- Hiccups are caused by a repetitive sudden involuntary contraction of the inspiratory muscles (predominantly the diaphragm) and terminated by the abrupt closure of the glottis, which stops the inflow of air and produces a characteristic sound.
- Hiccups are classified based on their duration: Hiccup bouts last up to 48 hours; persistent hiccups last >48 hours but <1 month; intractable hiccups last for >1 month.
- System(s) affected: nervous, pulmonary
- Synonym(s): hiccoughs; singultus
Can be a serious problem, particularly among the elderly
- Fetal hiccups are rhythmic fetal movements (confirmed sonographically) that can be confused with contractions.
- Fetal hiccups are a sign of normal neurologic development (1).
- Predominant age: all ages (including fetus)
- Predominant sex: male > female (4:1)
Self-limited hiccups are extremely common, as are intraoperative and postoperative hiccups.
Etiology and Pathophysiology
- Results from stimulation of ≥1 limbs of the hiccup reflux arc (vagus and phrenic nerves) with a “hiccup center” located in the upper spinal cord and brain (2)
- In men, >90% have an organic basis; in women, psychogenic causes are more common.
- Specific underlying causes include the following:
- CNS disorders: vascular lesions (AV malformation), infectious causes (meningitis, encephalitis), structural lesions (intracranial/brainstem mass lesions, multiple sclerosis, hydrocephalus, syringomyelia), posterior inferior cerebellar artery (PICA) aneurysm; seizure disorder
- Diaphragmatic irritation (tumors, pericarditis, eventration, splenomegaly, hepatomegaly, peritonitis)
- Irritation of the tympanic membrane
- Nerve irritation: pharyngitis, laryngitis, neck tumors
- Mediastinal and other thoracic lesions (pneumonia, aortic aneurysm, tuberculosis [TB], myocardial infarction [MI], lung cancer, rib exostoses)
- Esophageal lesions (reflux esophagitis, achalasia, Candida esophagitis, carcinoma, obstruction)
- Gastrointestinal disorders (gastritis, GERD, PUD, distention, cancer)
- Hiccups have been reported as an initial presentation of COVID-19
- Cardiovascular disorders (MI, pericarditis) (3)
- Hepatic lesions (hepatitis, hepatoma); pancreatic lesions (pancreatitis, pseudocysts, cancer)
- Inflammatory bowel disease; cholelithiasis, cholecystitis
- Prostatic disorders
- Appendicitis; postoperative, particularly with abdominal procedures
- Metabolic causes (uremia, hyponatremia, gout, diabetes)
- Drug-induced (dexamethasone, methylprednisolone, anabolic steroids, benzodiazepines, α-methyldopa, propofol, levofolinate, oxaliplatin, fluorouracil, carboplatin, cisplatin, tramadol) (4)
- Toxic (alcohol-induced)
- Psychogenic causes (anorexia, conversion, grief, malingering, schizophrenia, stress)
- Consuming carbonated beverages
- Excessive alcohol consumption
- Excitement or emotional stress
- Changes in ambient or gastrointestinal temperature
- Identify and correct relevant underlying cause(s).
- Avoid gastric distention.
- Acupuncture shows promise compared to chronic drug therapy for controlling hiccups (5).
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Domino, Frank J., et al., editors. "Hiccups." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688619/all/Hiccups.
Hiccups. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688619/all/Hiccups. Accessed May 29, 2023.
Hiccups. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688619/all/Hiccups
Hiccups [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688619/all/Hiccups.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hiccups ID - 1688619 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688619/all/Hiccups PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -