Malady Wise

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Hiccups

Involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles

More common if tall, old or male

Commonly repeat at cycles of 4 to 60 per minute

Acute

Try supra-supramaximal inspiration (SSMI) method first

  • Breath in and hold 10 seconds

  • Don’t exhale, and breath in a little more and hold for 5 more seconds

  • Don’t exhale still, and breath in more for a final 5 seconds

  • Then exhale

Other physical methods disrupt the hiccup arc

  • Breath holding for 5 to 10 seconds (or as tolerated).

  • Performing Valsalva manoeuvre, holding for five seconds.

  • Sipping on or gargling with very cold water.

  • Biting into a lemon.

  • Pulling on the tongue.

  • Swallowing a teaspoon of dry sugar.

  • Pressing gently but firmly on the eyeballs.

  • While sitting, pulling the knees up to the chest or leaning forward to compress the chest); hold the position for 30 seconds to one minute if possible.

  • Drinking water through a rigid tube with a valve that requires significant suction effort

Prolonged Hiccups

For prolonged hiccups due to specific causes > 48 hours

  • Assess for and treat underlying cause

  • If no cause trial PPI for 3 to 4 weeks

  • If persisting

    • Baclofen 5 to 10mg up to 3 times daily OR

    • Gabapentin 100 to 400mg up to 3 times daily

  • If persisting after 1-2 weeks of treatment

    • Metoclopramide 10mg up to 3 to 4 times daily

  • If persisting after 1-2 weeks of treatment

    • Chlorpromazine 10 to 25mg up to 3 times daily

  • If persisting consider interventional measures

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