Hiccups: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Hiccups=== | |||
*Central nervous system disorders | |||
**Vascular | |||
***Ischemic/hemorrhagic stroke, AV malformations, temporal arteritis | |||
**Infections | |||
***Encephalitis, meningitis, brain abscess, neurosyphillis, subphrenic abscess | |||
**Structural | |||
***Head trauma, intracranial neoplasms, brainstem neoplasms, multiple sclerosis, syringomyelia, hydrocephalus | |||
**Vagus and phrenic nerve irritation | |||
***Goiter, pharyngitis, laryngitis, hair or foreign body irritation of tympanic membrane, neck cyst or other tumor | |||
*Gastrointestinal disorders | |||
**Gastric distention, gastritis, peptic ulcer disease, pancreatitis, pancreatic cancer, gastric carcinoma, abdominal abscesses, gallbladder disease, inflammatory bowel disease, hepatitis, aerophagia, esophagael distention, esophagitis, bowel obstruction | |||
*Thoracic disorders | |||
**Enlarged lymph nodes secondary to infection or neoplasm*, pneumonia, empyema, bronchitis, asthma, pleuritis, aortic aneurysm, mediastinitis, mediastinal tumors, chest trauma, pulmonary embolism | |||
*Cardiovascular disorders | |||
**Myocardial infarction, pericarditis | |||
*Toxic-metabolic | |||
**Alcohol | |||
**Diabetes mellitus | |||
**Herpes zoster | |||
**Hypocalcemia | |||
**Hypocapnia | |||
**Hyponatremia | |||
**Influenza | |||
**Malaria | |||
**Tuberculosis | |||
**Uremia | |||
*Postoperative | |||
**General anesthesia | |||
**Intubation (stimulation of glottis) | |||
**Neck extension (stretching phrenic nerve roots) | |||
**Gastric distention | |||
**Traction on viscera | |||
*Drugs | |||
**Alpha methyldopa | |||
**Short-acting barbituates | |||
**Chemotherapeutic agents (eg, carboplatin) | |||
**Dexamethasone | |||
**Diazepam | |||
*Psychogenic | |||
**Anorexia nervosa | |||
**Conversion reaction | |||
**Excitement | |||
**Malingering | |||
**Schizophrenia | |||
**Stress | |||
==Diagnostic Evaluation== | ==Diagnostic Evaluation== |
Revision as of 14:45, 9 September 2015
Background
- Usually initiated by gastric distention from food, carbonated beverage, or air
- Also known as Singultus
Clinical Features
- Hiccups
Differential Diagnosis
Hiccups
- Central nervous system disorders
- Vascular
- Ischemic/hemorrhagic stroke, AV malformations, temporal arteritis
- Infections
- Encephalitis, meningitis, brain abscess, neurosyphillis, subphrenic abscess
- Structural
- Head trauma, intracranial neoplasms, brainstem neoplasms, multiple sclerosis, syringomyelia, hydrocephalus
- Vagus and phrenic nerve irritation
- Goiter, pharyngitis, laryngitis, hair or foreign body irritation of tympanic membrane, neck cyst or other tumor
- Vascular
- Gastrointestinal disorders
- Gastric distention, gastritis, peptic ulcer disease, pancreatitis, pancreatic cancer, gastric carcinoma, abdominal abscesses, gallbladder disease, inflammatory bowel disease, hepatitis, aerophagia, esophagael distention, esophagitis, bowel obstruction
- Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm*, pneumonia, empyema, bronchitis, asthma, pleuritis, aortic aneurysm, mediastinitis, mediastinal tumors, chest trauma, pulmonary embolism
- Cardiovascular disorders
- Myocardial infarction, pericarditis
- Toxic-metabolic
- Alcohol
- Diabetes mellitus
- Herpes zoster
- Hypocalcemia
- Hypocapnia
- Hyponatremia
- Influenza
- Malaria
- Tuberculosis
- Uremia
- Postoperative
- General anesthesia
- Intubation (stimulation of glottis)
- Neck extension (stretching phrenic nerve roots)
- Gastric distention
- Traction on viscera
- Drugs
- Alpha methyldopa
- Short-acting barbituates
- Chemotherapeutic agents (eg, carboplatin)
- Dexamethasone
- Diazepam
- Psychogenic
- Anorexia nervosa
- Conversion reaction
- Excitement
- Malingering
- Schizophrenia
- Stress
Diagnostic Evaluation
- Clinical diagnosis
- Consider auditory canal exam (foreign body against TM can trigger hiccups)
- Consider CXR
Management
- Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
- Remove foreign body from ear
- Swallow teaspoon of sugar
- Sip ice water
- Drink water quickly
- Meds
- Chlorpromazine 25–50mg IV; 25–50mg PO TID
- Metoclopramide 10mg IV or IM; 10–20mg PO TID x 10d
Disposition
- Discharge for uncomplicated hiccups