This document defines hiccups as involuntary contractions of the diaphragm muscle that cause a "hic" sound when the vocal cords close abruptly. It discusses the most common causes of short-term (less than 48 hours) hiccups like drinking carbonated beverages or alcohol, as well as potential causes of long-term hiccups like nerve damage or central nervous system disorders. Treatment options described include medications to relax the diaphragm muscle, procedures to block nerves, and home remedies, with surgery as a last resort for persistent hiccups.

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.

5. 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

6. 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

7. 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

8. 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

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

10. 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.

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

12. 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.

13. 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.

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

15. 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.

16. 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

18. Thanks…..