Hiccup ... Hiccup ..... Hiccup ... What's the ED evaluation and treatment of this condition?

Generally benign but if last > 48 hours a more thorough evaluation for the underlying etiology should be pursued. Causes include:

Central Nervous System

• infection


• structural lesions

Metabolic

• alcohol


• uremia


• diabetes mellitus


• hyponatremia


• hypocalcemia

Drugs

• general anesthesia


• dexamethasone


• diazepam

Vagus and phrenic nerve irritation

• foreign body against tympanic membrane irritates auricular branch of vagus nerve


• any mass or infection along pathway of vagus or phrenic from neck down to diaphram

Psychogenic

Idiopathic

• click here to see video of unfortunate man with intractable idiopathic hiccups

Pursue appropriate testing based on history and physical. For symptomatic relief consider chlorpromazine or metoclopramide while searching for underlying cause.

Source

Fishman, Mary MD. "Overview of hiccups." Up to Date. 4 September 2008.