Materiały źródłowe

• #1 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  Hiccups can be acute, lasting less than 48 hours, persistent, lasting over 2 days, or intractable, lasting more than one month. […] This activity reviews the spectrum of hiccups from acute to intractable, outlines the causes, and offers recommendations for medical treatment based on clinical presentation. […] Hiccups are a not uncommon occurrence that most people experience at some point in their lifetime. […] The classification of hiccups is by their duration. Acute hiccups are of less than 48 hours duration, persistent last over 2 days, and intractable last over a month. […] There are various causes of hiccups including organic causes, psychogenic, idiopathic, or medication-induced. Persistent and intractable hiccups may signify a more serious underlying etiology. […] Gastrointestinal processes, particularly gastroesophageal reflux disease (GERD) and associated hiatal hernias, are implicated as the most common cause of acute hiccups.

• #1 Hiccups, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17672-hiccups

  Hiccups usually go away on their own without any treatment. However, some people have hiccups that go on much longer than normal. You should call a healthcare provider if your hiccups last longer than two days. This could be a sign of a more serious condition that needs medical attention. […] If you have hiccups for just a few minutes, you likely wont think to call a healthcare provider. But you should call one if your hiccups last more than two days (persistent hiccups). They may ask you to come in for an appointment where theyll: […] Your provider will use this information to identify whats causing your persistent hiccups. Hiccups that wont go away are sometimes a sign of a more serious condition that needs diagnosis and treatment. […] Hiccups that last longer than two days are more than just a nuisance. They can interfere with your quality of life and lead to trouble with basic needs like eating or sleeping. Possible medications a healthcare provider may prescribe for you include: […] Call your healthcare provider if your hiccups last longer than two days.

• #1 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  The incidence of persistent hiccups is higher in patients with certain disorders, especially those with central nervous system disorders such as Parkinsons Disease, advanced cancer where the incidence may be as high as 4-9%, and 8-10% in those with gastroesophageal reflux disease (GERD). […] Evaluating a patient with hiccups warrants a thorough medical history review. […] In cases of persistent and intractable hiccups, one should investigate organic causes. […] Acute hiccups are typically benign and usually do not require a workup, however persistent and intractable hiccups should trigger a thorough evaluation to identify a treatable cause. […] Important steps in the treatment of persistent and intractable hiccups are, first, to assess whether the patient is using a medication known to induce hiccups, and second, to determine whether hiccups are associated with GERD.

• #1 Hiccups: Causes, treatments, and complications

  https://www.medicalnewstoday.com/articles/181573

  Hiccups happen when a persons intake of air becomes momentarily blocked. […] Hiccups that last for under 48 hours do not usually need any medical attention because they typically resolve on their own. If they persist for longer than this, the person should consult a doctor. […] If a bout of hiccups lasts for longer than 48 hours, this is considered persistent, and the person should contact a doctor. […] The doctor may ask: when the hiccups began, how often they occur, if they are happening all the time, what the person was doing before the hiccups started. […] If an underlying condition may be the cause, the doctor may order the following tests: blood tests to check for infections, kidney disease, or diabetes; imaging tests such as an X-ray, CT scan, or MRI scan to assess for any anatomical irregularities that may be affecting the phrenic or vagus nerves or the diaphragm; an endoscopic test, in which a healthcare professional passes an endoscope which is a flexible tube with a small camera at the end down the persons throat to check the windpipe or esophagus; an electrocardiogram to check for heart-related conditions by measuring electrical activity in the heart.

• #1 Diagnosing hiccups – how are hiccups diagnosed?

  https://www.mymed.com/symptoms/hiccups/diagnosing-hiccups

  Hiccup bouts are more common than persistent and intractable hiccups, and do not require an in-depth and detailed medical examination. […] However, chronic hiccups (persistent and intractable hiccups) require a more thorough and detailed evaluation in order for the underlying cause (i.e. aetiology) to be determined so as to design a successful treatment plan. […] A number of disorders that lead to chronic hiccups may be diagnosed by means of a thorough physical examination and medical history, bearing in mind that, for a number of patients, the specific cause is not always determined. […] Experts note that persistent hiccups that are also experienced during sleep suggest that the cause is organic as opposed to psychogenic. […] If a patient has advanced cancer, the exact cause of chronic hiccups tends to be multifactorial and requires a lengthy and thorough evaluation for the cause to be detected. Even when an exact cause is established, it is unlikely to change the way in which hiccups are managed. Due to this, doctors will typically focus on treating symptoms as opposed to performing extensive examinations and tests.

• #1 Hiccups – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiccups/diagnosis-treatment/drc-20352618

  During the physical exam, your health care provider may perform a neurological exam to check your: […] If your health care provider thinks that an underlying medical condition may be causing your hiccups, the provider may recommend one or more of the following tests. […] Samples of your blood may be checked for signs of diabetes, infection or kidney disease. […] Imaging tests may be able to detect issues inside your body that may be affecting your diaphragm or the nerve that controls your diaphragm, called the phrenic nerve. Or these tests may show issues with a main nerve in your nervous system, called the vagus nerve. Imaging tests may include a chest X-ray, a CT or an MRI. […] These procedures use a thin, flexible tube called an endoscope that contains a tiny camera that is passed down your throat and into your esophagus, sometimes called your food pipe. The purpose is to check for issues in your esophagus or your windpipe.

• #1 Hiccups – WikEM

  https://wikem.org/wiki/Hiccups

  Hiccups […] Clinical diagnosis […] Consider auditory canal exam (foreign body against TM can trigger hiccups) […] Consider Hyponatremia and Hypocalcemia […] Consider CXR […] Discharge for uncomplicated hiccups.

• #1 Diagnostics: Intractable Hiccups — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/intractable-hiccups

  November 18, 2024

• #1 Hiccups Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/775746-workup

  A wide variety of conditions may contribute to hiccups. The possibilities are narrowed down by the findings from the history and physical examination. Laboratory testing is directed toward suspected abnormalities. […] Imaging modalities that may be helpful in the workup of hiccups include the following: […] Other studies that may be helpful include the following:

• #1 Diagnosing Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/diagnosis

  Achalasia can also cause frequent hiccupping and difficulty belching. […] To diagnose achalasia, our doctors obtain information about your medical history and conduct a physical exam. In addition, they perform an esophageal high-resolution manometrythe gold standard test to diagnose achalasiaas well as other diagnostic tests. […] NYU Langone doctors offer high-resolution esophageal manometry, the most advanced technology available. Using this approach, doctors can identify the specific characteristics of achalasia, which can help them recommend the best treatment.

• #1 Hiccups Differential Diagnoses

  https://emedicine.medscape.com/article/775746-differential

  In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: […] Diagnostic Considerations […] Hiccups: a common problem with some unusual causes and cures. […] Hiccups: nerve irritation or masquerading as acute coronary syndrome. […] Diagnosis and management of hiccups in the patient with advanced cancer. […] Hiccups as a myocardial ischemia symptom. […] Hiccups: a new explanation for the mysterious reflex. […] Chronic hiccups: an underestimated Problem. […] Hiccups: a new explanation for the mysterious reflex. […] Hiccups in Patients With Cancer Often Overlooked, Undertreated.

• #1

  https://journals.lww.com/ajg/fulltext/2020/10001/s1948_a_minor_hiccup_unveiling_a_devastating_stage.1948.aspx

  A hiccup is often a minor complaint that can affect almost everyone in their lifetime. When persistent, it may reflect an ominous condition. We present a case where a clinic visit for the sole complaint of hiccups lead to the diagnosis of Stage IV Esophageal Adenocarcinoma. […] Albeit rare, hiccups and esophageal cancer have been historically associated. A systematic review found that 1-9% of patients with metastatic cancer described persistent hiccups. However, it has not been reported as a chief complaint leading to the diagnosis of esophageal cancer. […] Since the signs and symptoms of esophageal cancer are often subtle and nonspecific, recognition of hiccups as potential sign of esophageal cancer may play a role in early diagnosis and treatment.

• #1 WHEN IS IT MORE THAN HICCUPS? UNDERSTANDING THE DIAGNOSIS AND TREATMENT OF SUPERIOR MESENTERIC SYNDROME. – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.mystagingwebsite.com/abstract/when-is-it-more-than-hiccups-understanding-the-diagnosis-and-treatment-of-superior-mesenteric-syndrome/

  An 83-year-old male with a history of hypertension and coronary artery disease presented to the ED with complaints of persistent hiccups for 1-week duration associated with drooling, decreased appetite, inability to lie flat, and significant weight loss over several months. […] Superior mesenteric artery (SMA) syndrome is defined as an upper gastrointestinal mechanical obstruction caused by compression of the 3rd part of the duodenum between the SMA anteriorly and the aorta posteriorly that has an incidence of 0.1-0.3%. […] While SMA syndrome is typically treated with adequate nutrition, nasogastric decompression, and proper positioning of the patient after eating, this was not an option for this patient. […] This unique case stresses the importance of keeping a high clinical suspicion of SMA syndrome in the setting of severe weight loss with gastroduodenal distension and hiccups, as well as the prompt use of CT and endoscopy to diagnosis and assess the surgical approach.

• #1 Hiccups – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiccups/symptoms-causes/syc-20352613

  Spasms of your diaphragm that you can’t control cause hiccups. […] Make an appointment to see your health care provider if your hiccups last more than 48 hours or if they’re so severe that they cause issues with eating, sleeping or breathing. […] Issues that may cause hiccups to last more than 48 hours include nerve damage or irritation, central nervous system disorders, metabolic issues, and certain drug and alcohol problems. […] A cause of long-term hiccups is damage to, or irritation of, the vagus nerves or phrenic nerves. […] A tumor or infection in your central nervous system or damage to your central nervous system due to an injury can disrupt your body’s normal control of the hiccup reflex. […] Long-term hiccups may result when your body’s metabolism doesn’t work properly. […] Use of certain drugs or problems with alcohol may cause long-term hiccups. […] Ongoing hiccups may interfere with eating, drinking, sleeping and speaking.

• #1 A young woman with persistent nausea, vomiting and hiccups | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2021/10/educational-case-report/young-woman-persistent-nausea-vomiting-and-hiccups

  We describe the case of a young woman presenting with obstipation, persistent nausea, vomiting and hiccups. […] The diagnosis was confirmed by serological testing for anti-aquaporin-4 IgG antibodies. […] The clinical symptom of nausea, vomiting and hiccups, however, is more specific. […] Area postrema syndrome in anti-aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder is distinguished by acute or subacute onset nausea, vomiting and hiccups (individual or combined symptoms) with a duration of over 48 hours, and the exclusion of other aetiology. […] The syndrome consists of a triad of clinical symptoms: intractable hiccups, nausea and vomiting, and despite low incidence, these are still viewed as core clinical characteristics of the disorder, on a par with myelitis and optic neuritis.

• #1 Persistent Hiccups as a Rare Presenting Symptom of Pulmonary Embolism – The Western Journal of Emergency Medicine

  https://westjem.com/case-report/persistent-hiccups-as-a-rare-presenting-symptom-of-pulmonary-embolism.html

  Persistent Hiccups as a Rare Presenting Symptom of Pulmonary Embolism – The Western Journal of Emergency Medicine […] Hiccups are generally self-limiting benign contractions of the diaphragm that may be associated with medications or food but may also be symptomatic of serious disease when persistent. We report 3 cases of PE presenting as persistent hiccups. […] Hiccups have been associated with medications (steroids, dopamine, azithromycin, cefotetan, benzodiazepines, propofol), CNS disorders (tumors and vascular anomalies, multiple sclerosis and seizures), pulmonary disease (lung cancer), gastric and esophageal disease (GERD, herpetic esophagitis, gastric volvulus) and cardiac conditions (myocardial infarction, pacemaker lead injury). […] We report here 3 cases of pulmonary embolism presenting as persistent hiccups.

• #1 Hiccups: a common problem with some unusual causes and cures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5072913/

  In the present case, the CXR guided us to the diagnosis and CT was needed to confirm the cause of persistent hiccups: an acute aortic syndrome that caused thoracic aortic enlargement due to an intramural aortic haematoma. […] In the differential diagnosis of persistent hiccups, the following questions can help us: does it only happen when awake? Or does it occur day and night? […] Complications from hiccups are rare but they can occur and include discomfort, difficulty in feeding, gastro-oesophageal reflux, respiratory alkalosis (in tracheostomised patients), wound dehiscence, sleep deprivation, and psychiatric disorders. […] The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag).

• #1

  https://journals.lww.com/pbj/fulltext/2018/12000/intractable_hiccups_as_the_presenting_symptom_of.2.aspx

  Goiters, tumors, or cysts in the neck, mediastinal masses, and abnormalities of the diaphragm that irritate the phrenic nerve are common causes of persistent or intractable hiccups, so it was mandatory to exclude them in this case report. […] The exact mechanism provoking hiccups remains unknown. […] Toxic nodular goiter is a common cause of hyperthyroidism, second in prevalence only to Grave disease. […] The prevalence of toxic nodular goiter increases with age and in the presence of iodine deficiency. […] Although the introduction of iodized salt has eliminated many cases of goiter it still is very common and patients with long-standing goiters may develop symptoms of obstruction due to progressive compression of the trachea and phrenic nerve paralysis due to obstructive goiter.

• #1 Case Report: Two Cases of Persistent Hiccups Complicating COVID-19 in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 5 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/5/article-p1713.xml

  Two cases are presented with coronavirus disease 19 (COVID-19)-related hiccups: one during initial presentation and one 10 days after COVID-19 diagnosis. Hiccups in both patients were resistant to treatment and responded only to chlorpromazine. COVID-19 patients may present with hiccups and also may have hiccups after treatment. Resistant hiccups without any underlying disease other than COVID-19 should be considered in association with COVID-19 and may respond well to chlorpromazine. […] Pneumonia may rarely present with persistent hiccups, and hiccups may disappear after antibiotic treatment. A review of the literature reveals very few reported cases of pneumonia presenting with hiccups. […] The first case of COVID-19 pneumonia presenting with persistent hiccups was reported by Prince et al. A 62-year-old woman presented with a 4-day history of hiccups.

• #1 What are my hiccups telling me? | ScienceDaily

  https://www.sciencedaily.com/releases/2016/02/160211192345.htm

  Everyone gets hiccups in their life. The majority of the time they are completely harmless and are more of an irritant than a symptom of an underlying condition, but, if you experience hiccups that last more than 48 hours this could potentially signal serious health complications. […] „You should seek advice from your health care provider if your hiccups progress from happening every once in a while to becoming persistent or intractable,” said Timothy Pfanner, M.D., assistant professor of medicine at the Texas AM Health Science Center College of Medicine. […] Persistent hiccups are hiccups that last more than 48 hours but less than 30 days while intractable hiccups are classified as hiccups that last more than 30 days. […] „Generally, when someone is diagnosed with intractable hiccups, we start worrying that something more serious is going on internally,” Pfanner said. „However, since intractable hiccups are also a symptom of acid reflux disease it’s always important to discuss your symptoms with your physician.”

• #1 What are my hiccups telling me? | ScienceDaily

  https://www.sciencedaily.com/releases/2016/02/160211192345.htm

  Cancer is never a word thrown around lightly, and according to Pfanner, intractable hiccups could be a symptom of certain cancers. „Sometimes we see intractable hiccups in patients diagnosed with cancers of the brain, lymph nodes or stomach cancer,” he said. „They can also indicate stroke. It’s still unclear why many of these incidents occur.” […] „Persistent or intractable hiccups can indicate inflammation around the heart or a pending heart attack,” Pfanner said. „That’s why we always want patients who are experiencing these type of hiccups to immediately consult their health care provider.”

• #1 Hiccups Symptoms, Causes & Treatments | Spire Healthcare

  https://www.spirehealthcare.com/symptoms/hiccups/

  Hiccups that last more than two days or keep coming back could be a sign of an underlying medical condition. […] You can book an appointment with a Spire private GP today. […] See your GP if your hiccups last for more than 48 hours, keep coming back or are making it harder to eat, drink or sleep normally. […] Your GP will diagnose hiccups from your symptoms. They may refer you for other tests and scans to find out what is causing them, such as: An X-ray, Blood tests, CT scan, Endoscopy an examination using a tiny camera on the end of a flexible tube to see inside your throat, MRI scan. […] You should seek urgent medical attention if your hiccups occur alongside: Coughing up blood, Feeling as if your throat is closing up, Fever, Pain in your abdomen, Shortness of breath, Vomiting. […] If your hiccups are affecting your everyday life, your GP might recommend: Changing a medication that is causing your hiccups as a side effect, Medication to control your hiccups this is rare but if you have severe, persistent hiccups, your doctor may prescribe chlorpromazine, haloperidol or metoclopramide, Treatment for the underlying problem causing your hiccups. […] Depending on the cause of your hiccups, your GP may refer you to a specialist.

• #1 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  The most commonly studied drugs for persistent or intractable hiccups are metoclopramide and the GABA agonists baclofen and gabapentin. […] For cases refractory to medical therapy, more invasive techniques for management include acupuncture, positive pressure ventilation, vagus nerve stimulators, and stellate or phrenic nerve block. […] Hiccups are usually a self-limited process and relatively benign. Management of underlying etiologies typically improves the hiccup frequency and duration. […] Persistent and intractable hiccups can have profound effects on quality of life, with decreased ability to tolerate oral intake leading to dehydration, malnutrition, fatigue, and weight loss, as well as insomnia, despair, depression, and exhaustion. […] Hiccups are often benign and self-limiting. Patients with acute hiccups should be advised to try some aforementioned physical maneuvers and should receive reassurance.

• #1 Hiccups – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiccups/diagnosis-treatment/drc-20352618

  If an underlying medical condition is causing your hiccups, treating that condition may stop the hiccups. […] If your hiccups last longer than two days, medicines or certain procedures may be needed. […] Drugs used to treat long-term hiccups include baclofen, chlorpromazine and metoclopramide. […] If less invasive treatments aren’t effective, your health care provider may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups. […] Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it also has helped control long-term hiccups. […] You may initially talk with your family health care provider about your ongoing hiccups. Your health care provider may refer you to a specialist if you have long-term or severe hiccups. […] Your health care provider may ask: […] Preparing for questions will help you make the most of your time with your health care provider.

• #2 Hiccups – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1040

  Hiccups are a common and mostly harmless condition. […] Most hiccups are benign and self-limiting, rarely requiring medical attention. However, various organic causes can lead to chronic hiccups that can last for years. […] Chronic hiccups can lead to malnutrition, weight loss, dehydration, fatigue, depression, insomnia, and reduced quality of life. […] Various therapies have been described, from non-prescription remedies to mechanical stimulation of the involved anatomical structures. […] Most of the evidence for treatments of hiccups come from uncontrolled observational trials or case-control series or reports. Valid randomised trials are needed. […] A hiccup is an abrupt contraction of the inspiratory muscles that repeats several times per minute. The resultant sudden rush of air into the lungs causes the glottis to close, creating a distinctive 'hic’ sound.

• #2 Hiccups | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688619/all/Hiccups?q=Neck+mass

  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. […] Overall incidence in the general population is uncertain. […] Self-limited hiccups are extremely common, as are intraoperative and postoperative hiccups. […] Hiccups have been reported as an initial presentation of COVID-19. […] Identify and correct relevant underlying cause(s). […] Acupuncture shows promise compared to chronic drug therapy for controlling hiccups.

• #2 Hiccups: Causes, treatments, and complications

  https://www.medicalnewstoday.com/articles/181573

  Hiccups happen when a persons intake of air becomes momentarily blocked. […] Hiccups that last for under 48 hours do not usually need any medical attention because they typically resolve on their own. If they persist for longer than this, the person should consult a doctor. […] If a bout of hiccups lasts for longer than 48 hours, this is considered persistent, and the person should contact a doctor. […] The doctor may ask: when the hiccups began, how often they occur, if they are happening all the time, what the person was doing before the hiccups started. […] If an underlying condition may be the cause, the doctor may order the following tests: blood tests to check for infections, kidney disease, or diabetes; imaging tests such as an X-ray, CT scan, or MRI scan to assess for any anatomical irregularities that may be affecting the phrenic or vagus nerves or the diaphragm; an endoscopic test, in which a healthcare professional passes an endoscope which is a flexible tube with a small camera at the end down the persons throat to check the windpipe or esophagus; an electrocardiogram to check for heart-related conditions by measuring electrical activity in the heart.

• #2 Hiccups – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiccups/diagnosis-treatment/drc-20352618

  If an underlying medical condition is causing your hiccups, treating that condition may stop the hiccups. […] If your hiccups last longer than two days, medicines or certain procedures may be needed. […] Drugs used to treat long-term hiccups include baclofen, chlorpromazine and metoclopramide. […] If less invasive treatments aren’t effective, your health care provider may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups. […] Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it also has helped control long-term hiccups. […] You may initially talk with your family health care provider about your ongoing hiccups. Your health care provider may refer you to a specialist if you have long-term or severe hiccups. […] Your health care provider may ask: […] Preparing for questions will help you make the most of your time with your health care provider.

• #2 Diagnostics Test for Persistent Hiccups Symptom | Sprint Diagnostics Hyderabad

  https://www.sprintdiagnostics.in/symptoms/persistent-hiccups

  The investigations for persistent hiccups could include blood tests to check for diabetes or kidney disease, chest X-rays or CT scans to look for lung disorders or tumors, an endoscopy to check for GERD, or a neurological exam or brain imaging to check for neurological conditions. […] These investigations are crucial to identify the underlying cause of the persistent hiccups. This information is essential to formulate an effective treatment plan. […] The treatment for persistent hiccups depends on the underlying cause. It may include lifestyle changes, medication, and in some rare cases, surgery. Medications used can range from muscle relaxants to medications that affect the central nervous system. […] Yes, various medications can be used to treat persistent hiccups, including chlorpromazine, haloperidol, metoclopramide, and others. However, medication should only be taken under the direction of a healthcare professional.

• #2 Hiccups – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1040

  The first tests to order for diagnosis are clinical diagnosis. […] Tests to consider include 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, and pharyngoscopy.

• #2 Diagnostics: Intractable Hiccups — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/intractable-hiccups

  November 18, 2024

• #2 Hiccups | Canadian Cancer Society

  https://cancer.ca/en/treatments/side-effects/hiccups

  Hiccups are unintended spasms of the diaphragm followed by quick closing of the vocal cords. The exact cause of hiccups is not known. Hiccups may be caused by irritation of the nerves that control the muscles used for breathing, including the diaphragm. Hiccups affect men more often than women. […] If you have persistent or intractable hiccups, your doctor will try to find the cause. They may ask you questions about your medical history and do a physical exam. It is usually difficult to find the exact cause of hiccups. If your hiccups last a long time for no obvious reason, you may need to have the following tests: blood chemistry tests, chest x-ray, electrocardiogram (ECG), upper GI endoscopy exam of the esophagus, stomach and upper small intestine using an endoscope, pH monitoring of the esophagus measures how much acid the esophagus is exposed to, brain MRI, chest CT scan.

• #2 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  Hiccups can be acute, lasting less than 48 hours, persistent, lasting over 2 days, or intractable, lasting more than one month. […] This activity reviews the spectrum of hiccups from acute to intractable, outlines the causes, and offers recommendations for medical treatment based on clinical presentation. […] Hiccups are a not uncommon occurrence that most people experience at some point in their lifetime. […] The classification of hiccups is by their duration. Acute hiccups are of less than 48 hours duration, persistent last over 2 days, and intractable last over a month. […] There are various causes of hiccups including organic causes, psychogenic, idiopathic, or medication-induced. Persistent and intractable hiccups may signify a more serious underlying etiology. […] Gastrointestinal processes, particularly gastroesophageal reflux disease (GERD) and associated hiatal hernias, are implicated as the most common cause of acute hiccups.

• #2 Hiccups: a common problem with some unusual causes and cures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5072913/

  In the present case, the CXR guided us to the diagnosis and CT was needed to confirm the cause of persistent hiccups: an acute aortic syndrome that caused thoracic aortic enlargement due to an intramural aortic haematoma. […] In the differential diagnosis of persistent hiccups, the following questions can help us: does it only happen when awake? Or does it occur day and night? […] Complications from hiccups are rare but they can occur and include discomfort, difficulty in feeding, gastro-oesophageal reflux, respiratory alkalosis (in tracheostomised patients), wound dehiscence, sleep deprivation, and psychiatric disorders. […] The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag).

• #2 Persistent Hiccups as a Rare Presenting Symptom of Pulmonary Embolism – The Western Journal of Emergency Medicine

  https://westjem.com/case-report/persistent-hiccups-as-a-rare-presenting-symptom-of-pulmonary-embolism.html

  Persistent Hiccups as a Rare Presenting Symptom of Pulmonary Embolism – The Western Journal of Emergency Medicine […] Hiccups are generally self-limiting benign contractions of the diaphragm that may be associated with medications or food but may also be symptomatic of serious disease when persistent. We report 3 cases of PE presenting as persistent hiccups. […] Hiccups have been associated with medications (steroids, dopamine, azithromycin, cefotetan, benzodiazepines, propofol), CNS disorders (tumors and vascular anomalies, multiple sclerosis and seizures), pulmonary disease (lung cancer), gastric and esophageal disease (GERD, herpetic esophagitis, gastric volvulus) and cardiac conditions (myocardial infarction, pacemaker lead injury). […] We report here 3 cases of pulmonary embolism presenting as persistent hiccups.

• #2 Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-024-04500-8

  Hiccups are among the rare complications of COVID-19 infections. […] However, there are very few published reports of persistent hiccups occurring in the post-acute COVID-19 period. […] This case highlights an atypical presentation of persistent hiccups that manifested during the post-acute COVID -19 period that clinicians need to be aware of. […] A diagnosis of post-acute COVID-19 associated hiccups was made. […] This is one of the few published cases of COVID-19 associated persistent hiccups, occurring more than a month after the initial presentation. […] Consequently, hiccups occurring in the post-acute COVID-19 period may not be attributable to COVID-19. […] This case has highlighted the need to consider post-acute COVID-19 in the differential diagnosis of persistent hiccup.

• #2 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  The most commonly studied drugs for persistent or intractable hiccups are metoclopramide and the GABA agonists baclofen and gabapentin. […] For cases refractory to medical therapy, more invasive techniques for management include acupuncture, positive pressure ventilation, vagus nerve stimulators, and stellate or phrenic nerve block. […] Hiccups are usually a self-limited process and relatively benign. Management of underlying etiologies typically improves the hiccup frequency and duration. […] Persistent and intractable hiccups can have profound effects on quality of life, with decreased ability to tolerate oral intake leading to dehydration, malnutrition, fatigue, and weight loss, as well as insomnia, despair, depression, and exhaustion. […] Hiccups are often benign and self-limiting. Patients with acute hiccups should be advised to try some aforementioned physical maneuvers and should receive reassurance.

• #2 Diagnostics Test for Persistent Hiccups Symptom | Sprint Diagnostics Hyderabad

  https://www.sprintdiagnostics.in/symptoms/persistent-hiccups

  Red flag signs include hiccups that persist for more than 48 hours, severe abdominal pain, fever, shortness of breath, vomiting blood, or significant weight loss. These symptoms could indicate a more serious underlying condition, and medical attention should be sought immediately. […] Persistent hiccups can lead to complications such as fatigue, sleep disturbances, weight loss, and even psychological issues like anxiety and depression. […] While most cases of hiccups are harmless, persistent hiccups can sometimes be a sign of an underlying health issue like GERD, lung disease, stroke, or even cancer. Therefore, persistent hiccups should always be evaluated by a doctor.

• #2

  https://journals.lww.com/pbj/fulltext/2018/12000/intractable_hiccups_as_the_presenting_symptom_of.2.aspx

  Hiccups differential diagnosis is a challenging one often being inconclusive and sometimes attributed to malignancies, and so of extreme importance to an internist. […] Hiccups can lead to significant adverse outcomes including malnutrition, weight loss, fatigue, dehydration, insomnia, mental stress, and decreased quality of life. […] Several of the conditions associated with persistent and intractable hiccups can be diagnosed by a thorough history and physical examination. The persistence of hiccups during sleep suggests an organic rather than psychogenic etiology. […] Chest computed tomography (CT) scan is helpful to detect pulmonary and mediastinal abnormalities irritating the vagal or phrenic nerves or the diaphragm in patients presenting with hiccups. […] This deviation could be inducing abnormal excitation of the phrenic nerves leading to intractable hiccups.

• #2 Singultus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538225/

  The incidence of persistent hiccups is higher in patients with certain disorders, especially those with central nervous system disorders such as Parkinsons Disease, advanced cancer where the incidence may be as high as 4-9%, and 8-10% in those with gastroesophageal reflux disease (GERD). […] Evaluating a patient with hiccups warrants a thorough medical history review. […] In cases of persistent and intractable hiccups, one should investigate organic causes. […] Acute hiccups are typically benign and usually do not require a workup, however persistent and intractable hiccups should trigger a thorough evaluation to identify a treatable cause. […] Important steps in the treatment of persistent and intractable hiccups are, first, to assess whether the patient is using a medication known to induce hiccups, and second, to determine whether hiccups are associated with GERD.

• #2 Hiccup: Mystery, Nature and Treatment

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2012.18.2.123

  Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a hic sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. […] An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. […] Unfortunately, there is no guideline available to direct treating this serious disorders effectively. Chlorpromazine is approved by the US Food and Drug Administration as the only drug to treat hiccup until now. […] The effective hiccup treatment is exactly established upon a correct diagnosis of lesion responsible for the serious event. For example, after effective measures were undertaken to CNS lesions such as vascular ischemia and tumors, hiccup episodes subsided. Similarly, some peripheral lesions related hiccups responded well after these lesions were ablated.

• #2 FF #81 Management of Hiccups | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/management-of-hiccups/

  In most clinical scenarios, it is best to start with non-pharmacologic therapy and resort to pharmacologic options for refractory cases. […] Anti-Psychotics: Chlorpromazine – the only FDA approved drug for hiccups. […] Baclofen – the only drug studied in a double blind randomized controlled study for treatment of hiccups. […] Interventions: Acupuncture, diaphragmatic pacing electrodes, or surgical ablation of the reflex arc can be considered when other treatments fail.

• #2 EM@3AM: Hiccups – emDocs

  https://www.emdocs.net/em3am-hiccups/

  This is a clinical diagnosis. Sudden feeling of involuntary diaphragm contractions and inspiration followed by pause in breath and classic “hic” sound. Typically ranging from 30-100 hiccups per minute. Normally self-resolving by 48 hours of onset without intervention. Considered persistent if greater than 48 hours and intractable if greater than 1 month. Persistence during sleep may suggest organic cause. […] Conservative treatment typically involves glottic stimulation/manipulation. Breath holding. Large gulps of water. Drinking water upside-down. Vagal maneuvers. Pharyngeal vs. nasopharyngeal stimulation with nasopharyngeal tube or foley. […] Hiccups are common. Defined as intractable when persistent for greater than 48 hours. Do not miss organic causes: cardiac, neurologic, electrolyte, toxic ingestion/exposure, structural, cancer. Conservative treatment first, pharmacologic second line. No clear first-line drug choice. Consider case-by-case and side-effect profiles.

• #3 Hiccups (Singultus) – Signs and Symptoms – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.I.1.8.

  Hiccups (singultus) are involuntary synchronous contractions of the intercostal muscles and the diaphragm that cause sudden inspiration. This leads to an almost simultaneous closure of the glottis and is accompanied by a characteristic sound. […] The vast majority of episodes of hiccups are short, self-terminating, and inconsequential, requiring no investigation. […] Persistent hiccups (48 hours) may result in exhaustion, discomfort, weight loss (due to interference with food intake), insomnia, and depression. […] A thorough history and physical examination often elucidate the etiology of persistent hiccups. Routine supplemental investigations may include laboratory investigations (eg, complete blood count [CBC] and levels of creatinine and electrolytes including calcium), electrocardiography (ECG), and chest radiography.

• #3 Hiccups: Causes, treatments, and complications

  https://www.medicalnewstoday.com/articles/181573

  Hiccups happen when a persons intake of air becomes momentarily blocked. […] Hiccups that last for under 48 hours do not usually need any medical attention because they typically resolve on their own. If they persist for longer than this, the person should consult a doctor. […] If a bout of hiccups lasts for longer than 48 hours, this is considered persistent, and the person should contact a doctor. […] The doctor may ask: when the hiccups began, how often they occur, if they are happening all the time, what the person was doing before the hiccups started. […] If an underlying condition may be the cause, the doctor may order the following tests: blood tests to check for infections, kidney disease, or diabetes; imaging tests such as an X-ray, CT scan, or MRI scan to assess for any anatomical irregularities that may be affecting the phrenic or vagus nerves or the diaphragm; an endoscopic test, in which a healthcare professional passes an endoscope which is a flexible tube with a small camera at the end down the persons throat to check the windpipe or esophagus; an electrocardiogram to check for heart-related conditions by measuring electrical activity in the heart.

• #3 Hiccups (Singultus) – Signs and Symptoms – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.I.1.8.

  Depending on clinical presentation, additional tests may be performed: Abnormal chest radiographs should be followed by computed tomography (CT) of the chest. Neurologic findings on physical examination or in history may warrant CT or magnetic resonance imaging (MRI) of the head, and possibly lumbar puncture or electroencephalography. […] Referral to an ear, nose, and throat (ENT) specialist should be considered to evaluate identified abnormalities of the head and neck. GI findings may be further investigated with liver function tests, endoscopy, or abdominal ultrasonography and CT. For patients with respiratory abnormalities, spirometry and bronchoscopy may be appropriate.

• #3 Diagnosing Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/diagnosis

  Achalasia can also cause frequent hiccupping and difficulty belching. […] To diagnose achalasia, our doctors obtain information about your medical history and conduct a physical exam. In addition, they perform an esophageal high-resolution manometrythe gold standard test to diagnose achalasiaas well as other diagnostic tests. […] NYU Langone doctors offer high-resolution esophageal manometry, the most advanced technology available. Using this approach, doctors can identify the specific characteristics of achalasia, which can help them recommend the best treatment.

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