Hiccup

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Singultus

ICD-10	R06.6
ICD-9	786.8
DiseasesDB	5887
MedlinePlus	003068
eMedicine	emerg/252
MeSH	D006606

A hiccup or hiccough (pronounced /ˈhɪkʌp/ HICK-up), is the spasmodic contraction of the diaphragm that repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the epiglottis to close, creating the "hic" Hiccupsound.ogg (help·info) sound. In medicine, it is known as synchronous diaphragmatic flutter (SDF), or singultus, from the Latin, singult, "the act of catching one's breath while sobbing."^[1] The hiccup is an involuntary action involving a reflex arc.^[1]

The term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern.

A bout of hiccups, in general, resolves itself without intervention, although many home remedies claim to shorten the duration, and medical treatment is occasionally necessary in cases of chronic hiccups.

Contents 1 Causes 1.1 Phylogenetic hypothesis 2 Treatment 2.1 Medical treatment 2.2 Home remedies 3 Long-term cases 4 See also 5 Notes 6 External links

Causes

Hiccups (singultus) can be caused by many central and peripheral nervous system disorders, all from injury or irritation to the phrenic and vagus nerves, as well as toxic or metabolic disorders affecting the aforementioned systems. Hiccups often occur after drinking carbonated beverages or alcohol. Persistent or intractable hiccups may be caused by any condition which irritates or damages the relevant nerves. Chemotherapy—which includes a huge amount of different drugs—has been implicated in hiccups (some data states 30 percent of patients)^{[citation needed]}, while other studies have not proven such a relationship. Many times chemotherapy is applied to tumors sitting at places that are by themselves prone to cause hiccups, if irritated.^[2][3]

Phylogenetic hypothesis

Christian Straus and co-workers at the Respiratory Research Group, University of Calgary, Canada, propose that the hiccup is an evolutionary remnant of earlier amphibian respiration; amphibians such as frogs gulp air and water via a rather simple motor reflex akin to mammalian hiccuping.^[4] In support of this idea, they observe that the motor pathways that enable hiccuping form early during fetal development, before the motor pathways that enable normal lung ventilation to form; thus according to recapitulation theory the hiccup is evolutionarily antecedent to modern lung respiration. Additionally, they point out that hiccups and amphibian gulping are inhibited by elevated CO2 and can be completely stopped by the drug Baclofen (a GABAB receptor agonist), illustrating a shared physiology and evolutionary heritage. These proposals would explain why premature infants spend 2.5% of their time hiccuping, indeed they are gulping just like amphibians, as their lungs are not yet fully formed.^[5]

Treatment

Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them. However, there are a number of anecdotal treatments for casual cases of hiccups. Some of the more common home remedies include giving the afflicted a fright or shock, drinking water (sometimes in an unorthodox manner), holding one's breath and altering one's breathing patterns.

Medical treatment

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of a 15-year-old girl who, in 2007, hiccuped continuously for five weeks.^[6] Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. In severe or resistant cases, baclofen, an anti-spasmodic, is sometimes required to suppress hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating singultus is done short-term, as the affected individual cannot continue with normal life activities while taking the medication.

Digital rectal massage has been recommended as a remedy that causes immediate cessation of hiccups and which should be tried before resorting to drugs.^[7]

Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to normalize the potassium-sodium balance in the nervous system. The carbonation promotes quicker absorption. Carbonated beverages have though by themselves a tendency to provoke hiccup in some persons.

The administration of intranasal vinegar was found to ease the chronic and severe hiccups of a three-year old Japanese girl. Vinegar may stimulate the dorsal wall of the nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (the afferent of the hiccup reflex arc) is located.^[8]

Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy. In 2005, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression."^[9]

Home remedies

While numerous home remedies are offered, they mostly fall into three broad categories: purely psychosomatic cures centered around relaxation and distraction, cures involving swallowing and eating (with the general rationale that this would remove irritants or reset mechanisms in the affected region), and cures involving controlled/altered breathing.

Long-term cases

American man Charles Osborne had the hiccups for 68 years, from 1922 to 1990, and was entered in the Guinness World Records as the man with the Longest Attack of Hiccups.^[10]

In 2007, a teenager from Florida in the United States hiccuped around 50 times a minute for more than five weeks.^[11] After her hiccups returned, her neurologist suggested that she may have Tourette syndrome, and the hiccups may be a 'tic' caused by Tourette's.^[12]

See also

• Getting the wind knocked out of you
• Sneeze
• Cough

Notes

• "Fish Out of Water", Neil Shubin, Natural History, February 2008 issue, pages 26–31 - hiccup related to reflex in fish and amphibians.

External links

Look up hiccup in Wiktionary, the free dictionary.

• Hiccups - Considerations, Causes and Home Care (Healthbasis.com)
• BBC News: Why we hiccup
• Retrospective analysis of hiccups in patients at a community hospital from 1995-2000.
• Singer's Two-Year Hiccups Horror

v • d • e Symptoms and signs: circulatory and respiratory systems (R00-R09 · 785-786) Cardiovascular system Heart Tachycardia/Bradycardia · Palpitation Heart sounds: Heart murmur (Systolic, Diastolic, Continuous) · Gallop rhythm (Third heart sound, Fourth heart sound) · Pericardial friction rub · Split S2 · Heart click Pulse abnormalities Pulsus alternans · Pulsus bigeminus · Pulsus bisferiens · Pulsus tardus et parvus · Pulsus paradoxus Other peripheral blood flow Bruit/Carotid bruit · Gangrene · Cannon A waves Respiratory system Hemorrhage Epistaxis · Hemoptysis Abnormalities of breathing Respiratory sounds: Stridor · Wheeze · Rales · Rhonchi · Hamman's sign Dyspnea · Hyperventilation/Hypoventilation · Hyperpnea/Tachypnea/Bradypnea · Orthopnea/Platypnea Biot's respiration · Cheyne-Stokes respiration · Kussmaul breathing Hiccup · Mouth breathing/Snoring Other Asphyxia · Cough · Pleurisy · Sputum Respiratory arrest · Hypercapnia/Hypocapnia Whispered pectoriloquy · Egophony · Bronchophony Chest, general Chest pain see also eponymous medical signs for circulatory and respiratory systems