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

Resources

• SSMI Case study - Morris et al

• Hiccups - Up To Date