Hiccups

Hiccups causes and its management

1. Hiccups By: Dr. Waqar Hussain

2. Overview Definition Causes Risk Factors Investigations Treatment

3. Hiccup is an involuntary contraction (myoclonic jerk) of the diaphragm that may repeat several times per minute. The hiccup is an involuntary action involving a reflex arc. Once triggered, the reflex causes a strong contraction of the diaphragm followed about 0.25 second later by closure of the vocal cords, which results in the classic "hic" sound. Hiccups may occur individually, or they may occur in bouts. The rhythm of the hiccup, or the time between hiccups, tends to be relatively constant.

4. Causes The most common triggers for hiccups that last less than 48 hours include: Drinking carbonated beverages Drinking too much alcohol Eating too much Excitement or emotional stress Sudden temperature changes Swallowing air with chewing gum or sucking on candy

5. Hiccups that last more than 48 hours may be caused by a variety of factors, which are generally grouped into the following categories. Nerve damage or irritation Central nervous system disorders Metabolic disorders and drugs

6. Nerve damage or irritation The most common cause of long-term hiccups is damage to or irritation of the vagus nerves or phrenic nerves, which serve the diaphragm muscle. Factors that may cause damage or irritation to these nerves include: A hair or something else in ear touching your eardrum A tumor, cyst or goiter in neck Gastro esophageal reflux Sore throat or laryngitis

7. Central nervous system disorders A tumor or infection in central nervous system or damage to central nervous system as a result of trauma can disrupt body's normal control of the hiccup reflex. Examples include: Encephalitis Meningitis Multiple sclerosis Stroke Traumatic brain injury Tumors

8. Metabolic disorders and drugs Long-term hiccups can be triggered by: Alcoholism Anesthesia Barbiturates Diabetes Electrolyte imbalance Kidney failure Steroids Tranquilizers

9. Risk factors Men are much more likely to develop long-term hiccups than are women. Other factors that may increase your risk of hiccups include: Mental or emotional issues. Anxiety, stress and excitement have been associated with some cases of short-term and long-term hiccups. Surgery. Some people develop hiccups after undergoing general anesthesia or after procedures that involve abdominal organs.

10. Complications Prolonged hiccups may interfere with: Eating Sleeping Speech Wound healing after surgery

11. Investigations Laboratory tests for Diabetes, Kidney diseases, any infections such as serum electrolytes, urea and creatinine , CBC(TLC, DLC). Imaging Tests : Chest X-ray Computerized tomography (CT) Magnetic resonance imaging (MRI) Endoscopic tests - to visulaize esophagus and wind pipe.

12. Treatment Most cases of hiccups go away on their own without medical treatment. If an underlying medical condition is causing hiccups, treatment of that illness may eliminate the hiccups. The following treatments may be considered for hiccups that have lasted longer than two days.

13. Medications Drugs commonly used to treat long-term hiccups include: Chlorpromazine Metoclopramide Baclofen Proton-Pump Inhitors Lidocaine Haloparidol

14. Surgical and other procedures If less invasive treatments aren't effective, an injection of an anesthetic to block phrenic nerve to stop hiccups. Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it has also helped control persistent hiccups.

15. Lifestyle and home remedies Although there's no certain way to stop hiccups, if a bout of hiccups that lasts longer than a few minutes, the following home remedies may provide relief, although they are unproven: Breathe into a paper bag Gargle with ice water Hold your breath Sip cold water

16. Thanks…..