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Suggest Treatment For Violet Hiccups

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Posted on Wed, 11 Jun 2014
Question: My husband has had violent hiccups for a week. Is there any way to get relief?
doctor
Answered by Dr. Shafi Ullah Khan (2 hours later)
Brief Answer:
Prologed Hiccups Need Management

Detailed Answer:
Thank you for asking!
Brief episodes of hiccups are a common part of life; however, prolonged attacks are a more serious phenomenon and have been associated with significant morbidity and even death.
To know what is causing hiccups following issues need to be addressed as they are the major likely reasons for hiccups.
Surgical history
Comprehensive drug history
Indicators of psychogenic origin
Arrhythmia-induced syncope
Gastroesophageal reflux
Weight loss
Insomnia
Emotional distress
Alcoholism and acute alcohol ingestion

Then comes the role of examination of body parts thoroughly for example
Head – Foreign body or aberrant hair adjacent to tympanic membrane; glaucoma
Mouth - Pharyngitis
Neck – Inflammation; mass lesions; goiter; voice abnormalities; stiffness
Chest – Tumors; pneumonia; asthma
Cardiovascular system – Arrhythmias; myocardial infarction (MI); pericarditis; unequal pulses
Abdomen – Gastric atony; organomegaly; subphrenic abscess; cholecystitis; appendicitis; abdominal aortic aneurysm (AAA); pancreatitis; peritonitis
Rectum – Mass lesions
Nervous system – Focal lesions; disordered higher mental function; indications of multiple sclerosis

Then comes the role of Workup and labs and radiology imaging ot help the cause
Electrolytes - Hyponatremia, hypokalemia, hypocalcemia, and hyperglycemia
Renal function tests - Uremia
Liver function tests - Hepatitis
Amylase and lipase levels - Pancreatitis
White blood cell (WBC) count
Urine, sputum, or cerebrospinal fluid (CSF) - Infection
Imaging modalities that may be helpful in the workup include the following:
Chest radiography
Fluoroscopy of diaphragmatic movement
Computed tomography (CT) of the head, thorax, and abdomen
Magnetic resonance imaging (MRI)
Other studies that may be helpful include the following:

Electrocardiography
Nerve conduction studies
Endoscopy or bronchoscopy
esophageal acid perfusion test

Once the reason of Hiccups is diagnosed then the management is easy. It is divided in to two groups.
1)Pharmacological and 2) Non pharmacological.
Pharmacologic therapies include the following:

Chlorpromazine (drug of choice)
Haloperidol
Metoclopramide
Phenytoin
Valproic acid
Carbamazepine
Gabapentin
Ketamine
Baclofen
Lidocaine
Other agents reported to be beneficial are as follows:

Muscle relaxants (not benzodiazepines)
Sedatives
Analgesics (eg, orphenadrine, amitriptyline, chloral hydrate, and morphine)
Stimulants (eg, ephedrine, methylphenidate, amphetamine, and nikethamide)
Miscellaneous agents (eg, edrophonium, dexamethasone, amantadine, and nifedipine)
Nonpharmacologic therapies include the following:
a)Techniques affecting components of the hiccup reflex - Stimulation of the nasopharynx; C3-5 dermatome stimulation; direct pharyngeal stimulation; direct uvular stimulation; removal of gastric contents
b)Techniques leading to vagal stimulation - Iced gastric lavage; Valsalva manoeuvre; carotid sinus massage; digital rectal massage; digital ocular globe pressure
c)Techniques interfering with normal respiratory function - Breath holding; hyperventilation; gasping; breathing into a paper bag; pulling the knees up to the chest and leaning forward; continuous positive airway pressure; rebreathing 5% carbon dioxide
Mental distraction
Behavioral conditioning
Hypnosis
Acupuncture
Phrenic nerve or diaphragmatic pacing
Prayer
Surgical intervention (typically a last resort) may include the following:

Phrenic nerve ablation (unilateral or bilateral as appropriate)
Microvascular decompression of the vagus nerve if need be.

I hope it helps. Seek a gastroenterologist for further management and try non pharmacological manoeuvres meanwhile for the relief.
Take good care of your husband and don't forget to close the discussion please.
Regards
S Khan
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

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Suggest Treatment For Violet Hiccups

Brief Answer: Prologed Hiccups Need Management Detailed Answer: Thank you for asking! Brief episodes of hiccups are a common part of life; however, prolonged attacks are a more serious phenomenon and have been associated with significant morbidity and even death. To know what is causing hiccups following issues need to be addressed as they are the major likely reasons for hiccups. Surgical history Comprehensive drug history Indicators of psychogenic origin Arrhythmia-induced syncope Gastroesophageal reflux Weight loss Insomnia Emotional distress Alcoholism and acute alcohol ingestion Then comes the role of examination of body parts thoroughly for example Head – Foreign body or aberrant hair adjacent to tympanic membrane; glaucoma Mouth - Pharyngitis Neck – Inflammation; mass lesions; goiter; voice abnormalities; stiffness Chest – Tumors; pneumonia; asthma Cardiovascular system – Arrhythmias; myocardial infarction (MI); pericarditis; unequal pulses Abdomen – Gastric atony; organomegaly; subphrenic abscess; cholecystitis; appendicitis; abdominal aortic aneurysm (AAA); pancreatitis; peritonitis Rectum – Mass lesions Nervous system – Focal lesions; disordered higher mental function; indications of multiple sclerosis Then comes the role of Workup and labs and radiology imaging ot help the cause Electrolytes - Hyponatremia, hypokalemia, hypocalcemia, and hyperglycemia Renal function tests - Uremia Liver function tests - Hepatitis Amylase and lipase levels - Pancreatitis White blood cell (WBC) count Urine, sputum, or cerebrospinal fluid (CSF) - Infection Imaging modalities that may be helpful in the workup include the following: Chest radiography Fluoroscopy of diaphragmatic movement Computed tomography (CT) of the head, thorax, and abdomen Magnetic resonance imaging (MRI) Other studies that may be helpful include the following: Electrocardiography Nerve conduction studies Endoscopy or bronchoscopy esophageal acid perfusion test Once the reason of Hiccups is diagnosed then the management is easy. It is divided in to two groups. 1)Pharmacological and 2) Non pharmacological. Pharmacologic therapies include the following: Chlorpromazine (drug of choice) Haloperidol Metoclopramide Phenytoin Valproic acid Carbamazepine Gabapentin Ketamine Baclofen Lidocaine Other agents reported to be beneficial are as follows: Muscle relaxants (not benzodiazepines) Sedatives Analgesics (eg, orphenadrine, amitriptyline, chloral hydrate, and morphine) Stimulants (eg, ephedrine, methylphenidate, amphetamine, and nikethamide) Miscellaneous agents (eg, edrophonium, dexamethasone, amantadine, and nifedipine) Nonpharmacologic therapies include the following: a)Techniques affecting components of the hiccup reflex - Stimulation of the nasopharynx; C3-5 dermatome stimulation; direct pharyngeal stimulation; direct uvular stimulation; removal of gastric contents b)Techniques leading to vagal stimulation - Iced gastric lavage; Valsalva manoeuvre; carotid sinus massage; digital rectal massage; digital ocular globe pressure c)Techniques interfering with normal respiratory function - Breath holding; hyperventilation; gasping; breathing into a paper bag; pulling the knees up to the chest and leaning forward; continuous positive airway pressure; rebreathing 5% carbon dioxide Mental distraction Behavioral conditioning Hypnosis Acupuncture Phrenic nerve or diaphragmatic pacing Prayer Surgical intervention (typically a last resort) may include the following: Phrenic nerve ablation (unilateral or bilateral as appropriate) Microvascular decompression of the vagus nerve if need be. I hope it helps. Seek a gastroenterologist for further management and try non pharmacological manoeuvres meanwhile for the relief. Take good care of your husband and don't forget to close the discussion please. Regards S Khan