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Hiccups

We encounter Hiccups frequently in our practice and sometimes in the perioperative period.

here is a summary of the causes and the treatment,

Till now we do not know the exact science behind hiccups.



We do however have a good list of causes:
CNS disorders
metabolic disorders
meds
low potassium, low calcium
hyperventilation 
uremia


Brainstem lesions will respond well to steroids or radiation.

Chlorpromazine is the medication most often used (Thorazine, Taroctyl). However, this drug  has killed people when given too fast and can cause urinary retention, glaucoma exacerbations and hypotension.
Haloperidol (Haldol, Halidol) seems better tolerated but less studied.

Gabapentin may increase the release of GABA which would lower diaphragmatic excitability. It has no serious side effects and is well tolerated.  But the studies that it works are almost non existent.

PPIs may reduce GERD and could theoretically work.

Dexamethasone will help in AIDS related leukoencephalopathy.

Midazolam also helps to decrease them..

Lidocaine has a role in hiccups treatment...specially the nebulized lidocaine
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