Hiccups

Hiccups are forceful contractions of the inspiratory muscles produced by recurring, unpredictable contractions of the diaphragm. They can be persistent and distressing to patients. Hiccups are considered persistent if it last more than 48 hours.

• Gastric stasis / gastric distension (most common cause)
• Gastro-oesophageal reflux
• Diaphragmatic splinting (e.g. from hepatomagaly)
• Metabolic disturbances (e.g. uraemia, hypercalcaemia, hyponatremia)
• Medication (e.g. Steroids, Diazepam, Cisplatin, Etoposide, Paclitaxel)
• Irritation of diaphragm or phrenic nerve
• Cerebral causes (e.g. tumour, metastases)

General Care

• Reduce gastric distension with small meals
• Avoid triggers (e.g. medications, caffeine)
• Sit up after meals (for reflux)

Non Pharmacological Management

• Breath Holding
• Sneezing/ coughing
• Gargling with water
• Acupuncture
• Hypnotherapy

Pharmacotherapy
Treatment is directed at root cause if it can be identified

• 1^st line agents – Metoclopramide, Domperidone, Simethicone
• 2^nd line agents – Haloperidol, Chlorpromazine, Baclofen, Gabapentin
• 3^rd line agents – Nifedipine, Sodium valproate, Sertraline, Midazolam
• Phrenic nerve ablation as a last resort

For doses of drugs, please refer to Drug Formulary.

• Hum A, Koh M. Symptoms: hiccups. In: Hum A, Koh M, ed. The Bedside Palliative Medicine Handbook. Singapore, SG: Armour Publishing; 2013:35-38.
• Woelk CJ. Managing hiccups. Can. Fam. Physician. June 2011;57(6):672-675.
• Marinella MA. Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009;7(4):122-127,130.
• Regnard C. Hiccup. In: Doyle D, Hanks GWC, Cherny N, Calman KC, ed. Oxford Textbook of Palliative Medicine. 3rd Edition. New York, NY: Oxford University Press; 2004:477-479.