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Hiccups stress: Anxiety, stress trigger hiccups – Lifestyle* – southcoasttoday.com

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Anxiety, stress trigger hiccups – Lifestyle* – southcoasttoday.com

A case of the hiccups sure can be funny — at least, to the observer.

A case of the hiccups sure can be funny — at least, to the observer.

You feel a flip-flopping in your chest, your body jerks and jumps, and the telltale “hic” escapes your mouth sometimes quietly, sometimes quite loudly. In the space of one minute, some people will hiccup as little as four times, and some may hiccup as many as 60 times.

“There is no one who does not get hiccups,” says Hawthorne Medical Associates gastroenterologist James Tracey.

The root cause is a spasm of the diaphragm involved in breathing. Air is pulled into the lungs, but the vocal chords click shut in an untimely fashion to cause the “hic” sound.

Though Tracey says “nobody really knows what happens” to trigger the hiccups, the leading hypothesis is that many common things may stimulate one of the nerves that go to the diaphragm, resulting in usually harmless and short-lasting spasms.

Excitement, stress and anxiety are everyday causes of hiccups, and the current economy is making the world’s population hyperventilate. Tracey says that simple fact alone is triggering people to hiccup more often than ever.

This mostly harmless condition usually passes on its own. But, there are countless home remedies that Tracey says work primarily by distracting the hiccupper from focusing on his problem. A sprinkling of sugar on the tongue can work by drastically altering a person’s sense of flavor, and that can be enough to break the hiccupping cycle, Tracey explains. Drinking from the wrong side of the glass can work too, he says.

What few know, however, is that hiccups can be a sign of something serious — especially if they last for more than

48 hours or occur frequently. At the very least, exhaustion and malnutrition can result from long-term hiccups for the one out of 100,000 people who may get them for months at a time, according to the Mayo Clinic.

On the opposite end of the spectrum, a man in Great Britain who suffered from the hiccups for over two years, 25-year-old Christopher Sands, was recently diagnosed with an inoperable brain tumor as the underlying cause of his problem.

The Mayo Clinic reports that the most common triggers for short-term hiccups include eating too much, drinking carbonated beverages and consuming too much alcohol.

Hiccups that last more than 48 hours may be caused by a variety of factors, such as damage or irritation to the nerves serving the diaphragm muscle. The Mayo Clinic suggests one odd culprit could be a hair or something else in your ear touching your eardrum.

Central nervous system disorders, tumors or infections that interfere with the body’s ability to regulate the diaphragm can bring on relentless hiccups. Examples include stroke, multiple sclerosis, meningitis, encephalitis or traumatic brain injury.

Even more common maladies such as diabetes, kidney malfunctions or alcoholism can bring on hiccups that linger longer than normal.

For hiccups that aren’t linked to a serious underlying cause, but don’t go away on their own or respond to home remedies, the Mayo Clinic reports that the most common drugs used to treat them include chlorpromazine (a powerful antipsychotic), reglan (an anti-nausea drug) or lioresal (a muscle relaxant).

Not to worry, Tracey says. In his 17 years treating patients, he has only had one person turn to him for help with persistent hiccups, and that person knew ahead of time what his underlying cause was.

Much more frequently, Tracey says with a chuckle, the patient’s hiccups will go away on their own while he or she is sitting in his waiting room.

For the record, Tracey says members of his family swear by the stand-on-your-head-and-drink-water methods of getting rid of the pesky and silly-sounding spasms.

Hiccups – Better Health Channel

Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm. The diaphragm is a large sheet of muscle slung beneath the lungs that, together with the intercostal muscles, causes us to breathe. The muscular spasm of these muscles sucks air into the lungs, and the quick inhalation makes a structure inside the throat (called the epiglottis) slam shut. (The epiglottis is a flap of tissue that closes over the windpipe during swallowing to prevent the inhalation of food, fluids or saliva. ) This sharp closure of the epiglottis causes the characteristic ‘hic’ sound of hiccups.

Generally, hiccups resolve by themselves after a few minutes, but prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders. Certain drugs, including epilepsy medications, can make a person more prone to hiccups.

Symptoms of hiccups

The symptoms of hiccups include:

  • A sharp contraction or spasm of the diaphragm that is felt just below the breastbone.
  • Air is involuntarily sucked into the throat.
  • The closing epiglottis makes a ‘hic’ sound.
  • Hiccups usually stop after a few minutes.

Cause of hiccups

The muscular activity of the diaphragm is controlled by nerves. Hiccups occur when particular stimuli trigger the nerves to send the diaphragm into spasms. It is not known why this occurs.

Triggers of hiccups

The cause of hiccups is often unknown and there may be no apparent trigger. Various triggers, particularly those that cause pressure on the diaphragm, are known to prompt an attack of hiccups in some people from time to time. Some of these triggers include:

  • Eating food too quickly
  • Hot or spicy foods
  • Indigestion
  • Overconsumption of alcohol
  • Fizzy drinks
  • Cigarette smoking
  • Stress
  • Bad odours
  • Pregnancy.

Self-help strategies

Hiccups are harmless and usually resolve by themselves in a few minutes. Some hiccup ‘cures’ include:

  • Hold your breath
  • Take deep breaths
  • Breathe into a paper bag
  • Eat a bit of fresh ginger
  • Suck on a lemon
  • Have a hot water and honey drink
  • Eat a spoonful of sugar
  • Drink a glass of water slowly
  • Eat ice
  • Gargle
  • Sit down and lean forward over your knees
  • Ask someone to give you a fright.

Hiccups may be symptomatic of disease

Hiccups that last for days, weeks or even years may be symptomatic of underlying disease. Certain lung or brain disorders can sometimes interfere with the functioning of the diaphragm and make the person prone to hiccups. Hiccups may also be a side effect of surgery or particular medications.

Some of the diseases, conditions and drugs that may prompt frequent or prolonged attacks of hiccups include:

  • Oesophagitis (inflammation of the oesophagus)
  • An overactive thyroid gland
  • Pleurisy (inflammation of the membrane surrounding the lungs)
  • Pneumonia (inflammation of the lungs)
  • Kidney disease
  • Brain damage, such as stroke or tumour, that affects the area of the brain which controls the diaphragm
  • Abdominal surgery
  • Chest surgery
  • Certain epilepsy medications
  • Nicotine gum

Medical treatment

Prolonged hiccups should be medically investigated. Treatment options may include:

  • Treatment for the underlying disorder
  • Changes to current drug dosages
  • Switching to another form of nicotine therapy
  • Anti-spasmodic drugs to calm the diaphragm
  • A tube inserted into the nose (nasogastric intubation)
  • A nerve block
  • Surgery, to sever some of the nerves servicing the diaphragm.

Where to get help

Things to remember

  • Hiccups, or hiccoughs, are involuntary sounds made by spasms of the diaphragm.
  • Hiccups are usually harmless and resolve by themselves after a few minutes.
  • In some cases, prolonged hiccups that last for days or weeks may be symptomatic of underlying disorders.

Hiccups: Causes & Treatment



Overview

What are hiccups?

Hiccups are repeated spasms of your diaphragm paired with a ‘hic’ sound from your vocal cords closing. Your diaphragm is a muscle under your ribcage, separating your chest and stomach area. This muscle is an important part of the breathing process. It moves downward when you breathe in and upward when you breathe out.

Two things happen when you hiccup:

  • Your diaphragm pulls down between breaths, making you suck in air.
  • The glottis (space between the vocal cords) closes to stop more air coming in.

These actions make the ‘hic’ sound of the hiccup. The process of the hiccup happens very quickly and you’ll usually return to normal within minutes to a couple of hours without treatment.

Can hiccups happen to anyone?

Yes. Hiccups can happen to adults, children and babies.

Who commonly gets hiccups?

Hiccups are more common in men. They can also have hiccups for a longer period.



Symptoms and Causes

What causes hiccups?

It’s not clear why people get hiccups. There are several reasons hiccups might happen, including low levels of carbon dioxide in the blood and irritated nerves. The phrenic nerve (which connects the neck to the diaphragm) and vagus nerve (which connects the brain to the stomach) are important parts of the breathing process.

Mild hiccups (those that go away in a short time) can happen when you:

  • Eat and drink too quickly.
  • Drink carbonated beverages or alcohol.
  • Eat too much.
  • Experience stress – including fear and excitement.
  • Over-stretch your neck.
  • Take drugs (particularly those for anxiety – benzodiazepines).
  • Drink a very hot or very cold drink.
  • Go through chemotherapy.
  • Are anesthetized for a procedure.
  • Inhale toxic fumes.

What does it mean if the hiccups last for more than two days?

If your hiccups don’t go away within a few days, they are called ‘persistent.’ If they last for a few months they are called ‘intractable’ (long-lasting hiccups). Long-lasting hiccups are rare. They can be stressful and exhausting. Intractable hiccups can be part of a larger, underlying medical problem and might not go away until that issue is corrected.

Some of these larger, underlying conditions include:

  • Cancer and tumors.
  • Stroke.
  • Disorders of the stomach or esophagus, including GERD (a gastrointestinal and abdominal disorder).
  • Pleurisy of the diaphragm.
  • Uremia.
  • Pneumonia.
  • Bowel diseases.
  • Pancreatitis and bladder irritation.
  • Hepatitis and liver cancer.
  • Tumors and lesions.

Hiccups can also happen after surgery and during the recovery process from a procedure. See a healthcare provider if your hiccups last for a long period of time.



Diagnosis and Tests

How are hiccups diagnosed?

Diagnosing hiccups is not complicated. Your healthcare provider needs only to listen to the ‘hic’ sound.

However, your healthcare provider may perform a physical examination to see if an underlying condition may be causing your hiccups. If the physical examination reveals anything of concern, he or she may order tests such as imaging tests, endoscopic tests and lab tests.

What questions might my healthcare provider ask?

  • How long have you had hiccups?
  • How often do you hiccup?
  • Have you tried any home remedies to fix your hiccups?
  • Are you interested in taking medication to fix your hiccups?
  • Do you have GERD?
  • Is there a history of cancer in your family? Strokes? Tumors?
  • Are you experiencing any other symptoms?



Management and Treatment

How do I treat hiccups?

Because the exact cause of hiccups is uncertain, some remedies may or may not work. These home treatments will not hurt you, so there is typically no harm in trying them. Home treatments include:

  • Drinking water quickly.
  • Swallowing granulated sugar, dry pieces of bread, or crushed ice.
  • Gently pulling on your tongue.
  • Gagging (sticking a finger down your throat).
  • Gently rubbing your eyeballs.
  • Gargling water.
  • Holding your breath.
  • Breathing into a paper bag (do not use a plastic bag).

Are there any medications I can take for serious hiccups?

Hiccups that last for a long time can be treated by medication. Prescription drugs used for long-lasting hiccups include:

  • Gabapentin.
  • Baclofen.
  • Chlorpromazine.

What are the side effects of long-term hiccups?

  • Trouble eating.
  • Trouble sleeping (including insomnia) and feeling tired.
  • Some people feel embarrassed.

How do I stop my kid’s hiccups?

Babies get hiccups just like children, teenagers and adults. In fact, even babies in the womb can get hiccups! Babies under 12 months often get hiccups and they’re unharmed by them. If you want, you can try to stop them by breastfeeding or giving them some water. However, if the hiccups don’t stop after a couple of hours, see your healthcare provider.

Kids can try the home treatments listed above.

Never hesitate to contact your pediatrician if you have a concern about your child.



Prevention

How are hiccups prevented?

Sometimes medications taken before a treatment can prevent hiccups from happening. For example, hiccups caused by anesthesia can be prevented by taking metoclopramide beforehand. Steroids with ramosetron might prevent chemotherapy-related hiccups.

Again, mild hiccups (those that go away in a short interval) can happen because of the following. Therefore, you may try to avoid the following to prevent hiccups from happening. Try not to:

  • Eat and drink too quickly.
  • Drink carbonated beverages or alcohol
  • Eat too much.
  • Experience stress – including fear and excitement.
  • Over-stretch your neck.
  • Take drugs (particularly those for anxiety – benzodiazepines).
  • Drink a very hot or very cold drink.
  • Go through chemotherapy.
  • Are anesthetized for a procedure.
  • Inhale toxic fumes.



Outlook / Prognosis

How long will I have hiccups?

Hiccups can last minutes, hours, days or, if severe, weeks. The longest known and recorded bout of hiccups lasted 60 years!

Can hiccups go away on their own?

Yes. Often no treatment is needed, either home remedies or treatment provided by your healthcare provider.



Living With

Can I live a normal life with hiccups?

Hiccups shouldn’t prevent you from enjoying your daily activities.

When should I go see a healthcare provider?

If your hiccups last only minutes to a couple of hours, you probably don’t need to see your healthcare provider. However, if the hiccups last more than a few days (typically two), you should see him or her. When the hiccups happen at the same time as symptoms like a headache, trouble keeping your balance, or numbness, it can be a sign of something more serious. If you have those symptoms with hiccups, see your healthcare provider immediately or go to the nearest emergency room.

A note from Cleveland Clinic

Hiccups are usually harmless. Most stop without treatment, or with simple home remedies. They don’t reduce your quality of life. However, remember to keep an eye on how long they last. Hiccups may be a symptom of a serious illness, or they could just be annoying.

Why You Get Hiccups ..and How To Make Them Stop

Once is funny, twice is hilarious, and anything more than that is usually just annoying. We’ve all had them, but do you actually know where they come from? They’re hiccups, and they’re the strange little sounds that can escape from your mouth without warning.

Hiccups start much lower in your body, though — in the diaphragm, the dome-shaped muscle between your lungs and stomach. Normally, the diaphragm pulls down when you inhale to let air into your lungs, and then relaxes when you exhale so air can flow back out of your lungs to exit your nose and mouth.

But if something irritates your diaphragm, it can spasm, forcing you to suddenly suck air into your throat, where it hits your voice box. That makes your vocal cords suddenly close, creating the distinct “hic!” sound.

Why Do Hiccups Happen?

Hiccups can happen for a lot of reasons — some of them are physical, and some emotional. That’s because the actual irritation happens in the nerve connecting the brain to the diaphragm. Some common causes include:

  • Eating too much or too quickly
  • Feeling nervous or excited
  • Drinking carbonated beverages or too much alcohol
  • Stress
  • A sudden change in temperature
  • Swallowing air while sucking on candy or chewing gum

Long-term Hiccups

Hiccups are usually temporary, but in rare cases, they can stick around — for a while. It’s usually because of damage or aggravation to the nerves connected to the diaphragm. Everything from a hair touching your eardrum to a sore throat can affect these nerves, and in more serious cases, a tumor, goiter, or cyst in the neck can damage them.

Hiccups that last a while can also be because of central nervous system disorders like encephalitis or meningitis, or metabolic disorders like diabetes or kidney failure. Drugs like steroids or some tranquilizers can trigger long-term hiccups, too.

And even certain procedures, especially ones that require anesthesia, can give you hiccups. If you’ve been hiccupping for more than 2 days, or if they are severe enough to interfere with eating, breathing, sleeping or are causing you distress, you should make an appointment with your doctor.

Also, talk to your doctor immediately if you have any kind of stomach pain, fever, shortness of breath, vomiting, or cough up blood with your hiccups.

How to Make Them Stop

If you’re hoping that hanging upside down or having a friend scare you will get your hiccups to stop, we hate to disappoint you. But there’s no scientific proof that these remedies work.

However, some experts think holding your breath or breathing into a paper bag might do the trick; both techniques make carbon dioxide build up in your lungs, which might relax the diaphragm.

If all else fails, and your hiccups continue for several days or more, your doctor may try different medications to see if they can put an end to those uncomfortable hiccups. Good luck!

Hiccups, Chronic – NORD (National Organization for Rare Disorders)

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:240.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:545.

Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:745.

Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. W.B. Saunders Co., Philadelphia, PA; 1996:442-43.

REVIEW ARTICLES

Moretti R, Torre P, Antonello RM, et al. Gabapentin as a drug therapy of intractable hiccup because of a vascular lesion: a three-year follow up. Neurologist. 2004;10:102-06.

Smith HS, Busracamwongs A. management of hiccups in the palliative care population. Am J Hosp Palliat Care. 2003;20:149-54.

Friedman NL. Hiccups: a treatment review. Pharmacotherapy. 1996;16:986-95.

JOURNAL ARTICLES

Nagayama T, Kaji M, HiranoH, et al. Intractable hiccups as a presenting symptom of cerebellar hemangioblastoma. Case report. J Neurosurg. 2004;100:1107-10.

Witoonpanich R, Pirommai B, Tunlayadechanont S. Hiccups and multiple sclerosis. J Med Assoc Thai. 2004;87:1168-71.

Morgan JA, Ginsburg ME, Sonett JR, et al. Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology. Eur J Cardiothorac Surg. 2003;23:883-87.

Strate T, Langwieler TE, Mann O, et al. Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease. Surg Endosc. 2002;16:1109.

Dobelle WH. Use of breathing pacemakers to suppress intractable hiccups of up to thirteen years duration. ASAIO J. 1999;45:524-25.

Funakawa I, Terao A. Intractable hiccups and syncope in multiple sclerosis. Acta Neurol Scand. 1998;98:136-39.

FROM THE INTERNET

Martell B. Hiccups. Medical Encyclopedia. MedlinePlus. Update Date: 5/4/2003. 2pp.

www.nlm.nih.gov/medlineplus/ency/article/003068.htm

Wilkes G. Hiccups emedicine. Last Updated: January 11, 2005. 20pp.

www.emedicine.com/emerg/topic252.htm

Clark C. Dealing with cases of hiccups. The Pharmaceutical Journal. 30 October 2004. 2pp.

www.pjonline.com

Shmerling RH. The Myth and Mystery of Hiccups. IntelliHealth. March 9, 2004. 5pp.

www.intelihealth.com/IH/ihtIH/WSIHW000/ 35320/35323/376581.html?d=dmtHMSContent

Singultus (Hiccups). National Center for Emergency Medicine Informatics. NCEMI. nd. 2pp.

www.ncemi.org/cse/cse0601.htm

Singultus – StatPearls – NCBI Bookshelf

Continuing Education Activity

Hiccups can be acute, lasting less than 48 hours, persistent, lasting over 2 days, or intractable, lasting more than one month. They can result from a variety of causes. In particular, hiccups are often caused by gastrointestinal disorders such as gastroesophageal reflux. Other causes include medication side-effects, cardiovascular disorders, central nervous system disorders, ear, nose, and throat disorders, psychogenic disorders, or metabolic disorders. Ths activity reviews the spectrum of hiccups from acute to intractable, outlines the causes, and offers recommendations for medical treatment based on clinical presentation. This activity stresses the role of the interprofessional team in the care of affected patients.

Objectives:

  • Outline medications and medical conditions known to cause hiccups.

  • Describe useful bedside maneuvers for aborting acute hiccups.

  • Identify medical therapies for aborting persistent or intractable hiccups.

  • Explain a well-coordinated interprofessional team approach to provide effective care to patients affected by persistent or intractable hiccups.

Earn continuing education credits (CME/CE) on this topic.

Introduction

Hiccups are a not uncommon occurrence that most people experience at some point in their lifetime. The medical term is singultus, which derives from the Latin “singult” meaning ‘to catch one’s breath while sobbing.’  Hiccups result from a sudden and involuntary contraction of the diaphragm and intercostal muscles. An abrupt closure of the glottis follows the contractions which produces the characteristic “hic” sound. Often, these episodes are transient and resolve within 48 hours. They can occur in adults, children, infants, and in utero. In adults, they serve no physiological purpose. The belief is that they may play a role in respiratory muscle training in utero.[1]  Acute hiccups can be uncomfortable, and a brief annoyance, however persistent and intractable hiccups have a significant impact on quality of life by interfering with eating, sleeping, speaking, and social activities, and can be a harbinger of serious medical pathology.[2]

Etiology

The classification of hiccups is by their duration. Acute hiccups are of less than 48 hours duration, persistent last over 2 days, and intractable last over a month. As acute hiccups are self-limited and usually unreported, most of the research has focused on persistent and intractable hiccups. There are various causes of hiccups including organic causes, psychogenic, idiopathic, or medication-induced. Persistent and intractable hiccups may signify a more serious underlying etiology.

Gastrointestinal processes, particularly gastroesophageal reflux disease (GERD) and associated hiatal hernias, are implicated as the most common cause of acute hiccups.[3][4]  The incidence of hiccups in GERD patients has been reported as high as 10%.[5]  Distension of the stomach by large meals or carbonated beverages or irritation from spicy foods or alcohol are common associations. In patients with esophageal tumors, as many as one in four can present with persistent hiccups.[6]  Similarly, overexcitement or anxiety, especially if accompanied by over breathing or air swallowing (such as with laughing fits), can trigger the hiccups reflex. [7]

Many drugs correlate with hiccups, especially alcohol. Some drugs, such as benzodiazepines, have a dose-dependent and an inverse relationship with hiccups. At low doses, benzodiazepines correlate with the development of hiccups. At higher doses, they may be useful in the treatment of hiccups. Chemotherapeutic agents and some glucocorticoids have shown a strong association with hiccups. Nearly 42% of patients taking both cisplatin and dexamethasone develop hiccups.[8][9] Other medications associated with hiccups include various chemotherapeutic agents, alpha-methyldopa and inhaled anesthetics.

Numerous reports exist of persistent and intractable hiccups due to a multitude of etiologies, including:

  • Cardiovascular disorders: atrial pacing, aortic aneurysm (thoracic or abdominal), catheter ablation of atrial fibrillation, myocardial infarction, pericarditis, temporal arteritis

  • Central nervous system (CNS) disorders: aneurysms (especially posterior inferior cerebellar artery), encephalitis, lateral medullary syndrome,[10] meningitis, multiple sclerosis, neuromyelitis optica,[11] neoplasms (astrocytoma, brain stem tumor), Parkinson disease, seizure, stroke, syringomyelia, vascular malformations (cavernoma)[12][13][14]
  • Drugs: alpha-methyldopa, aripiprazole, azithromycin, benzodiazepines (diazepam, midazolam), chemotherapeutics (carboplatin, cisplatin, etoposide, fluorouracil, irinotecan, levofolinate, oxaliplatin), dexamethasone, donepezil, ethanol, levodopa, methohexital, morphine, pergolide, piribedil, sulfonamides, tramadol

  • ENT disorders: a cough, foreign body irritation of tympanic membrane (e.g., hair), goiter, laryngitis, neck cyst, neoplasms, pharyngitis, recent intubation

  • Infectious disorders: Helicobacter pylori, herpes simplex, herpes zoster, influenza, malaria, neurosyphilis, tuberculosis

  • Intrathoracic disorders: asthma, bronchitis, diaphragmatic tumor or a hernia, empyema, lymphadenopathy, mediastinitis, neoplasms, pleuritis, pneumonia, pulmonary embolus

  • Gastrointestinal disorders: aerophagia, bowel obstruction, gastric distention, esophageal cancer, esophagitis (infectious or erosive),[15] gallbladder disease, gastric distention, hepatitis, neoplasms, pancreatitis, peptic ulcer disease, stomach volvulus, subphrenic abscess
  • Metabolic/endocrine disorders: hypocapnia, hypocalcemia, hypokalemia, hyponatremia, diabetes mellitus, uremia

  • Psychogenic disorders: excitation, hyperventilation, malingering, somatization, stress[16][17] 
  • Surgery: anesthetic agents (barbiturates, bupivacaine epidural, isoflurane, methohexital, propofol), bronchoscopy, gastric insufflation during endoscopy, post-operative,[18] tracheostomy, sedation during endoscopy (20% incidence)[19]

Epidemiology

Hiccups occur in all ages, from in utero to the elderly.  The incidence and prevalence of hiccups in the community are unknown, and there does not appear to be differences based on racial or geographic variation.  Reports suggest there are as many as 4,000 admissions yearly in the U.S. for hiccups.[20]  Intractable hiccups have a predominance for older males, with an odds ratio of 2.4, and those with greater height and weight.[5][21][22][23] The incidence of persistent hiccups is higher in patients with certain disorders, especially those with central nervous system disorders such as Parkinson’s Disease, advanced cancer where the incidence may be as high as 4-9%, and 8-10% in those with gastroesophageal reflux disease (GERD).[7][5][24][25]

Pathophysiology

Hiccups are thought to be due to a complex reflex arc composed of three main units. Any condition that acts on one of these pathways has the potential to induce hiccupping. 

First, the afferent limb is composed of the vagus nerve, the phrenic nerve, and the peripheral sympathetic nerves supplying the viscera. Second, the central processing unit likely involves the interaction between various midbrain and brainstem structures, such as the medulla oblongata and reticular formation, chemoreceptors in the periaqueductal gray, glossopharyngeal and phrenic nerve nuclei, solitary and ambiguous nuclei, hypothalamus, temporal lobes and upper spinal cord at levels C3 to 5.[9][20]  Central neurotransmitters involved in this reflex include dopamine, gamma-aminobutyric acid (GABA) and serotonin.[20][26]  Third, the efferent portion of the reflex is composed of the phrenic nerve supplying the diaphragm and the accessory nerves supplying the intercostal muscles.[20] 

Hiccups commonly repeat at cycles of 4 to 60 per minute, depending on the individual. The diaphragmatic spasm is often unilateral, and the left hemidiaphragm is involved more than the right.[2]  After diaphragmatic spasm, the reflex is completed by activation of the recurrent laryngeal nerve causing closure of the glottis. Without closure of the glottis, hyperventilation would occur.[20]  Hiccups are inhibited by elevations in partial pressure of carbon dioxide (PCO2), vagal maneuvers, GABA-ergic agents (such as baclofen, gabapentin) and dopamine antagonists (such as chlorpromazine, haloperidol, metoclopramide) or agonists (amantadine).[26]  Hiccups become persistent as a form of diaphragmatic myoclonus due to excess activity of the solitary nucleus of the medulla.[27][28]

History and Physical

Evaluating a patient with hiccups warrants a thorough medical history review. Ask about precipitating causes, such as large meals, excitement or emotional stress.  Inquire regarding associated symptoms such as gastroesophageal reflux, coughing, weight loss, and abdominal pain. Ask about neurologic symptoms that might suggest a medullary stroke, multiple sclerosis or Parkinson’s disease.  Hiccups during sleep are uncommon and can occur with gastroesophageal, neurologic or pulmonary disorders, but negate psychogenic cause.  Ask about recent surgery, known cancer or chemotherapy.  A detailed medication review may identify a likely cause, and if discontinuing this offending medication provides significant relief then causality is confirmed. 

In cases of persistent and intractable hiccups, one should investigate organic causes. A full HEENT evaluation may reveal processes such as a hair or foreign body pressing against the tympanic membrane, masses, goiters, tonsillitis, and pharyngitis.  Listen to the lung sounds to assess for thoracic causes such as pneumonia or empyema.  Palpate the abdomen for tenderness or mass to exclude obstruction, volvulus, pancreatitis, hepatitis or mass.  A full neurological exam may expose CNS pathology such as strokes and tumors, though it is rare for hiccups to be the only presenting symptom.

Evaluation

Acute hiccups are typically benign and usually do not require a workup, however persistent and intractable hiccups should trigger a thorough evaluation to identify a treatable cause.  It is reasonable to obtain lab work for evaluation of electrolyte abnormalities or to rule out infectious and neoplastic processes not identified on history and physical exam.  Laboratory studies such as electrolytes, calcium, blood urea nitrogen (BUN), creatinine, lipase, and liver tests can be useful.  A chest radiograph may identify intrathoracic sources of hiccups such as pneumonia, empyema, diaphragmatic hernia, adenopathy or aortic disease.[29] 

The guiding of further imaging or interventions is best by the duration of hiccups, history and physical exam findings.  For persistent or intractable hiccups associated with neurologic symptoms or signs, brain imaging by computerized tomography (CT) or magnetic resonance imaging (MRI) may demonstrate causes such as stroke, multiple sclerosis, tumor, syringomyelia, neuromyelitis optica, aneurysm or vascular malformation.[30] In rare cases, cerebrospinal fluid is necessary to exclude meningitis or encephalitis. For some cases, thoracic or abdominal CT imaging may identify cancer, aneurysm, abscess or a hernia.  Referral to gastroenterology for upper endoscopy is essential to exclude lesions (such as esophageal cancer) in those cases of persistent hiccups refractory to initial antacid and proton pump inhibitor therapy.

It is essential to review blood gases in any ventilated patient that develops hiccups. Hiccups in ventilated patients may cause ventilator desynchronization, severe respiratory derangements, and hemodynamic changes.[31]  

Treatment / Management

In the acute phase, hiccups are likely to be terminated by a variety of simple physical maneuvers supported by anecdotal evidence. Most of the maneuvers aim for some portion of the hiccup reflex arc.  The frequency of hiccups decrease as PCO2 rises,[32] so Valsalva, breath holding, and breathing into a paper bag may be therapeutic.  Supra-supramaximal inspiration is a technique where subject exhales completely, then inhale deeply and hold for 10 seconds, then without exhaling inhale two times again, each time holding for 5 seconds.[33]  Other techniques include stimulation of the vagus nerve through the nose, ear, and throat by using cold drinks, pulling on the tongue,[34] pressure on the carotid, eyeballs or in both external auditory canals, sipping vinegar, swallowing sugar, stimulating the uvula or posterior nasopharynx (with smelling salts or nasal vinegar), Valsalva maneuver, and gargling, gagging or even self-induced vomiting.[7][35] More bizarre techniques reported have included sexual stimulation and digital rectal massage.[36][37] There are reports of suboccipital release and osteopathic/chiropractic manipulation techniques.[38][39]  All of these techniques appear to be much more effective in the acute phase. The persistent phase is usually multifactorial and more difficult to treat. 

 Important steps in the treatment of persistent and intractable hiccups are, first, to assess whether the patient is using a medication known to induce hiccups, and second, to determine whether hiccups are associated with GERD. Discontinuation of an offending medication or use of an alternative agent (such as methylprednisolone instead of dexamethasone) can resolve medication-induced hiccups.[40]  With as many as 80% of persistent hiccup cases related to GERD,[41][3] an initial therapeutic trial of antacids, antihistamines (such as famotidine) or proton pump inhibitor (such as omeprazole) may be successful,[42][41] and this approach has been suggested as first-line therapy.[7]  

In the persistent phase, most studies have evaluated pharmacotherapies acting on one or more components of the reflex arc. Pharmacotherapy is aimed at neurotransmitters and can be broken down into central and peripheral treatments though some act on both. The neurotransmitters involved in central processing include GABA, dopamine, and serotonin. Peripherally, they include acetylcholine, histamine, epinephrine, and norepinephrine. Classically, chlorpromazine had been the drug of choice for persistent hiccups and remains the only drug for hiccups approved by the U.S. Food and Drug Administration (FDA). Chlorpromazine acts as an antagonist on multiple central and peripheral neurotransmitter sites including dopamine, serotonin, histamine receptors, alpha-adrenergic receptors, and muscarinic receptors.[20] Due to the multiple sites of action, the drug may have significant side effects for some patients. Other typical antipsychotics, such as haloperidol or risperidone, have been tried with varying degrees of success. Often, the side effects of the typical antipsychotic drugs may be unbearable for the patient.

The most commonly studied drugs for persistent or intractable hiccups are metoclopramide and the GABA agonists baclofen and gabapentin.[26] Compared to the typical antipsychotics, these three drugs have a better side effect profile. If no etiology is found with a thorough exam, metoclopramide, gabapentin or baclofen are reasonable second-line therapies. Metoclopramide acts centrally as a dopamine antagonist and peripherally by increasing gastric motility and has been successful in relief of hiccups from cancer, stroke and brain tumors.[7][43]  Baclofen acts to decrease neuroexcitation and induce muscle relaxation and has been effective for intractable hiccups in stroke patients and idiopathic causes without gastroesophageal disease.[44][45][46] Similarly, gabapentin, structurally similar to GABA, decreases neuroexcitation by binding voltage-gated calcium channels and decreasing the release of excitatory neurotransmitters. In one case series, gabapentin has been reported to be 66 to 88% effective in cancer and brainstem stroke patients.[9][24][27]

There are a variety of medications suggested for the treatment of persistent hiccups in anecdotal reports such as amantadine,[47] amitriptyline, antipsychotic agents (haloperidol, risperidone, olanzapine),[9] atropine, benzonatate, carvedilol, glucagon, ketamine, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid.[26] Treatment for intraoperative hiccups has been with various intravenous medications including atropine, ephedrine, dexmedetomidine, ketamine, and lidocaine.[48]  Several other delivery methods have found use with local anesthetic including oral viscous lidocaine,[49] lidocaine gel in the external auditory canal,[50] and subcutaneous infusions.[51]

For cases refractory to medical therapy, more invasive techniques for management include acupuncture, positive pressure ventilation, vagus nerve stimulators,[52]and stellate or phrenic nerve block.[53][54] Small trials support acupuncture with promising results for intractable hiccups in the setting of cancer and stroke.[55][56][57] Given the relatively low complication rate with a potential benefit, it may be a reasonable alternative for some patients who are too sick or elderly to undergo pharmacotherapy or more invasive techniques.[58]  Positive pressure ventilation with elective intubation has shown to work in some case reports.[59] If considering cutting or blocking the phrenic nerve for symptomatic relief, it is important to ensure both hemi-diaphragms are functional prior to the procedure. 

Differential Diagnosis

  • The diagnosis of hiccups is relatively easy to make though it could be confused with coughing or gagging

  • Numerous medications can lead to hiccups

  • Hiccups may occur during anesthesia, endoscopy, sedation, and during the post-operative period

  • Hiccups are often a manifestation of other diseases, and the list of differentials can be extensive – these include but are not limited to ear, nose and throat, CNS, cardiovascular, gastrointestinal, infectious, intrathoracic, metabolic and psychogenic disorders

Prognosis

Hiccups are usually a self-limited process and relatively benign. Management of underlying etiologies typically improves the hiccup frequency and duration. 

Complications

Acute hiccups result in temporary discomfort, GERD, emotional disturbance and rarely aspiration, however persistent and intractable hiccups can have profound effects on quality of life, with decreased ability to tolerate oral intake leading to dehydration, malnutrition, fatigue, and weight loss, as well as insomnia, despair, depression, and exhaustion.[2] Intubated neuro ICU patients who develop hiccups may have complications from ventilatory desynchronization and hemodynamic changes.  Hiccups can interfere with surgery or threaten the integrity of post-operative thoracic or abdominal wounds.  Forceful hiccups can lead to bradycardia, carotid dissection, barotrauma such as pneumothorax or pneumomediastinum, and decreased venous return leading to hypotension.[60]

Deterrence and Patient Education

Hiccups are often benign and self-limiting. Patients with acute hiccups should be advised to try some aforementioned physical maneuvers and should receive reassurance. In healthy patients with no overt cause for intractable and persistent hiccups, treatment of reflux may provide relief. Patient education and therapies aimed at improving reflux and gastrointestinal motility are reasonable first steps. The provider should give guidance on the potential for any quality of life issues that may occur.

Pearls and Other Issues

  • An extensive diagnostic workup is usually not necessary in healthy patients with acute hiccup presentations

  • Acute hiccups can often be easily terminated by maneuvers that increase the partial pressure of carbon dioxide or stimulate the vagus nerve

  • Persistent hiccups can result from a variety of medications especially dexamethasone, benzodiazepines, opioids, chemotherapeutics, and anti-Parkinson medications

  • GERD is a common cause of persistent hiccups, and antacids, antihistamines or proton pump inhibitors are recommended as first-line therapy especially when no other cause is identifiable

  • GABA agonists and dopamine antagonists are standard recommendations for persistent hiccups especially in cases caused by cancer or neurologic disease

  • Intractable hiccups unrelieved by medications may require invasive intervention such as vagal nerve stimulator or stellate or phrenic nerve block

Enhancing Healthcare Team Outcomes

Those with persistent and intractable hiccups may present to the emergency department, urgent care clinics, health clinics, or to their primary care physicians for evaluation. Providers in these settings may initiate treatment based on history and physical examination. A full history and physical should be obtained to rule out more serious underlying etiologies. Any area of concern should prompt consultation with the appropriate specialist. It is crucial for triage nurses and other healthcare providers to recognize that hiccups may seem insignificant, but the complaint deserves a detailed history and thorough examination. 

Consultation and referrals are appropriate if there is an apparent or suspected underlying condition, and the patient is either not a candidate for outpatient therapy or has failed outpatient therapy. Patients who fail initial outpatient therapy and have no apparent cause may require referral to gastroenterology for endoscopy, and/or otolaryngology, neurology or pulmonology. In rare situations, intractable cases might need a referral to anesthesia for nerve block.

Hiccups are not an infrequent complaint among those with cancer in hospice care. As recurrent hiccups can be detrimental to the quality of life, it would be prudent for palliative care physicians and nurses to develop treatment regimens to address these complaints.[24]

Continuing Education / Review Questions

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Can Cats Get Hiccups? Here are some cat facts about cat hiccups.

August 3, 2020

We’ve all experienced our share of hiccups, but can cats get them, too? Have you ever noticed a behavior in your feline pal that seems similar to hiccups in humans? Is it really hiccups, or something else? Let’s take a look.

What a “Hiccup” Actually Is

When you hiccup, you’re experiencing a contraction of your diaphragm. The diaphragm is the muscle that sits between your lungs and stomach. When functioning normally, this muscle pulls downward when you inhale and relaxes to let air out as you exhale. The involuntary spasm of the diaphragm, which is what we know to be a ‘hiccup’, is the muscle’s reaction to an irritant.

This irritation actually occurs in the nerve that connects your diaphragm to your brain, which is why hiccups can be brought on by both physical and emotional factors. These causes and factors include:

  • Eating too quickly
  • Eating too much
  • Drinking carbonated beverages
  • Sudden changes in temperature
  • Stress and anxiety
  • Chewing gum

The noise you might hear when you hiccup is your vocal chords closing suddenly. Though only in rare cases, hiccups can also be a symptom of an underlying disease. So if these are the facts about human hiccups, is the same true for your cat?

Hiccups in Felines

Cats get hiccups in a similar way to and for similar reasons as humans. In felines, overeating or eating too quickly are the primary causes of hiccups. If food isn’t chewed properly, it can cause excess ingestion of air, which is what leads to the irritation and, in turn, the spasm of the diaphragm.

Anxiety is another cause of hiccups that humans and cats both experience. In some cases, emotional distress like discomfort or separation anxiety in your cat will lead to odd physical symptoms like hiccups.

However, there’s a common cause of hiccups in cats that humans don’t experience: hairballs. When cats groom themselves, they tend to ingest a hair or two as they use their tongues to clean their fur. The hairs can be irritating to your cat’s throat and the spasm can help them loosen or cough up the fur.

When to be Concerned About Your Cat’s Hiccups

If your cat’s bouts of hiccups are infrequent and short-lived, there’s typically nothing to worry about. On the other hand, if your feline pal seems to be getting hiccups frequently, or their bouts are lasting longer than usual, it could be a sign of a medical condition that should be treated by your cat care specialist. Some underlying conditions that may cause your cat to experience abnormal hiccups include:

  • Organ disease
  • Heart disease
  • Tumors
  • Neurological disorders
  • Ingestion of a foreign object
  • Severe allergies
  • Parasites

Wondering if Your Cat’s Hiccups are Normal?

Hiccups are more common in young kittens than in older cats, but no matter your cats age, shape, or size, it can be concerning when you witness them experiencing hiccups for the first time. Whether your cat has been having more hiccups than usual or you’re simply trying to determine the cause of the spasms they are having, the veterinary specialists at Catonsville Cat Clinic can help. We know that when it comes to your cat’s health, you’d rather be safe than sorry, which is why we’re here to provide medical advice and cat care for pet owners throughout the area.

Reach out today to schedule an appointment.

 

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This entry was posted on Monday, August 3rd, 2020 at 8:58 am.
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90,000 Doctors discovered a new non-obvious symptom of COVID-19

https://ria.ru/20210210/ikota-1596909024.html

Doctors discovered a new non-obvious symptom of COVID-19

Doctors discovered a new non-obvious symptom of COVID-19 – RIA Novosti. 02/10/2021

Doctors have discovered a new non-obvious symptom of COVID-19

Prolonged hiccups may be one of the rare symptoms of COVID-19, writes Express. RIA Novosti, 10.02.2021

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MOSCOW, Feb 10 – RIA Novosti. Prolonged hiccups may be one of the rare symptoms of COVID-19. The publication describes several cases of the disease taken from medical practice. They are all united by the fact that the patients experienced hiccups. At the same time, their tests for coronavirus were positive, the results of computed tomography also confirmed the diagnosis. It is also noted that the hiccups passed along with the first signs of recovery.The National Health Service of Great Britain confirmed that the coronavirus really affects the diaphragm, as a result of which the patient can hiccup for a long time. However, doctors warn that hiccups often occur for no reason and last for several minutes. This can be stress, intense emotional distress, or the body’s reaction to food or drink. In their opinion, a person should see a doctor only if he has hiccups for more than two days or if hiccups recur regularly.

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Treatment of hiccups in an adult in Yekaterinburg

Hiccups are an involuntary process associated with contraction of the intercostal muscles and the diaphragm.It can be physiological and goes away on its own, but it can be pathological, caused by a disease.


Classification and causes

Hiccups arise from a reflex motor act involving the diaphragm, which is located on the border of the chest and abdominal cavity. Outwardly, it looks like a membrane involved in breathing. Due to the contraction of the diaphragm, air flows from the environment to the lungs and back.

The work of this organ is controlled by the vagus and phrenic nerves.When they are irritated, a nerve impulse appears that goes to the cerebral cortex, signaling the need for contraction of the diaphragmatic muscles. This causes an extraordinary sharp exhalation through the narrow glottis. This accelerated air flow is the cause of the characteristic sound.

The duration of hiccups is subdivided into:

  • episodic, which lasts no more than 10-15 minutes,
  • persistent with symptoms for 2 days,
  • non-recoverable for more than 2 months.

Intermittent hiccups are normal. It occurs due to improper diet, quick snacks, bloating, eating very cold or hot food, stress, and excessive swallowing of air through the mouth.

With pathological hiccups, it is subdivided according to the localization of the lesion. Central occurs after an acute disturbance of cerebral circulation, with tumors, trauma or inflammation of the brain. Peripheral is associated with damage to the phrenic nerve and its branches.It occurs when it is squeezed by scar tissue, with hiatal hernia (HH), tumors of the stomach or pancreas.

The same symptoms are caused by diseases of the heart and blood vessels – myocardial infarction, significant rhythm disturbances. The phrenic nerve is involved in lung diseases – pneumonia, bronchitis.

The use of certain medications, significant concomitant diseases such as diabetes mellitus, various intoxications: alcohol or smoking, metabolic disorders such as hypocalcemia also lead to hiccups.


Diagnostics

There are many reasons for this symptom, so you first need to conduct a thorough diagnosis of the patient, find out where the lesion is located or is it a physiological process.

An anamnesis of the disease, physical examination data, as well as laboratory and instrumental examination methods play an important role in finding the cause of hiccups. The patient needs to be told how long he has been worried about the existing symptoms, the possible features of their occurrence, whether he went to the doctor or whether breathing was restored on its own.

Additionally, the doctor will prescribe:

  • general and biochemical blood test,
  • if necessary, ECG, X-ray or CT of the chest organs,
  • EGD, MRI of the brain,
  • Lumbar puncture for suspected neuroinfection.

These studies will be enough to identify the lesion, to establish the cause of the hiccups.


Treatment methods

If the hiccups are episodic, go away on their own, and the patient has no other accompanying symptoms, then in this case, no medical intervention is performed.You can use a number of physiological methods to get rid of hiccups. All of them are aimed at breaking the pathological reflex arc.

Such activities often help – to breathe in a bag, hold your breath, lightly press on the eyeballs, bring the legs to the stomach, press a little on the chest. Symptoms disappear in a couple of minutes if you hold a piece of ice or lemon in your mouth.

In a different situation, depending on the cause, the doctor prescribes the appropriate treatment. Muscle relaxants, antidepressants, antiarrhythmics, and other drugs aimed at etiological treatment of the disease can be used as drug therapy.

With significant HHP with complications or tumor lesions of the brain, digestive tract organs, surgical intervention may be required.


Prevention and prognosis

You can prevent the appearance of physiological hiccups by observing the following rules. Breakfast, lunch or dinner should be done slowly, chewing thoroughly, which will exclude excessive swallowing of air. Also, you should not eat dry, too cold or hot food.

It is necessary to undergo regular examination by a doctor so as not to miss any disease. Avoid hypothermia or dehydration. Follow the principles of a balanced diet.

With regard to working capacity and life, the prognosis is favorable. Hiccups are not a threatening condition, if you do not consider the intractable form. However, it can disrupt sleep, daily activities, dehydration, chronic fatigue, weight loss, and starvation.


Conclusion

In most cases, hiccups are a physiological reflex that does not require medical intervention, does not threaten the patient’s life or health. However, it is worth paying attention to this symptom. With prolonged attacks, you do not need to self-medicate, but you should consult a doctor for a thorough diagnosis and a full examination, so as not to miss a serious illness.


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How to get rid of hiccups and what does it threaten?

“It’s a trifle, but unpleasant” – think, hiccuping, many of us.But this problem is far from trivial, and if you close your eyes to it, you can then be very sorry.

Breath will have to stay

To begin with, a sudden involuntary contraction of the diaphragm and intercostal muscles (the full scientific name of the problem), in a number of cases, leads to serious consequences: chronic fatigue, dehydration, psychological breakdowns, insomnia and other troubles. Prolonged hiccups often cause dysfunctions of the phrenic nerve, as a result of which you risk suddenly losing your life: the glottis closes, and the supply of oxygen to the lungs stops – the person suffocates.

But even without knowing anything about such a terrible prospect, people really do not like to hiccup and by all means try to get rid of inexplicable and unexpected attacks. The most common advice is to hold your breath for as long as possible and, after a long retention of air, feel relief from this misfortune. For some, the method works, for others – not too much.

Alcohol. But not cognac

There are other recommendations, each of which, however, is a double-edged sword.For example, gargling with ice cold water is unlikely to work for someone with a sore throat. Or, let’s say, advice to eat a slice of lemon: this citrus is contraindicated in people with diagnoses of pancreatitis, stomach ulcers and gastritis. And here is an instruction for those who are fond of yoga: bring the legs, bent at the knees, to the stomach and chest, squeezing the chest with them. A person with sore joints will immediately remember the phrase “we treat one thing, we cripple the other.”

Another variation on the theme of Indian spiritual practices: bend at the lower back and drink water from a glass on the floor through a straw.Not everyone, alas, is capable of such an acrobatic sketch, but he freed many from hiccups. Someone else sniffs ammonia and calls it a panacea … The main conclusion from all valuable (and not so) indications: today there is no fully proven and universal way to quickly overcome hiccups. And, therefore, it is better not to bring it to her, otherwise she will bring us to the handle.

Food without harm

To knock the object out of the rut, hiccups seem to be quite tough: it is capable of “taking prisoner” for tens of days and even for several months! So let’s talk about prevention.Excessive consumption of soda of all kinds, alcohol, stress, overeating – these are the main triggers for hiccups (although there is no definite answer here either). As for food, it is often the food that triggers a mechanism called “hiccup”. For example, a snack on the go with the absorption of food in large chunks or a dry meal can make you hiccup seriously and for a long time. The word “dry food” again reminds of the most popular folk remedy – a glass of cool water. Note that the liquid in it is cool, not hot.And certainly not intoxicating.

To drink or not to drink? Sure, not a problem!

For those who often suffer from hiccups, alcohol is one of the main irritants. First, hiccuping is a direct consequence of the extensive intoxication of the body, characteristic of a drinking person. Secondly, the liver, enlarged from abundant libations, presses on the diaphragm, forcing it to contract again. And alcohol in this situation is a deadly enemy: during a hiccup in a drunk, the risk of a microinfarction sharply increases.Therefore, the advice “do not drink” (or drink rarely and dosed) does not cause any doubts here: it has been tested on many victims of Bacchus.

On the other hand, another popular recommendation – “a sudden fright will relieve hiccups” – is better not to check on those who have drunk. Trying to scare someone who is very drunk can cause a frustrating reaction. And then a sober one will be scared instead of a drunken one.

What else you need to know about hiccups

  • Short-term (10-15 minutes), rarely occurring hiccups should not make you sound the alarm.A good reason to see a doctor is long-term hiccups (from several days to several months).

  • If the hiccups persist for a long time, it can cause choking attacks.

  • Sometimes hiccuping notifies of serious illnesses: gastritis, problems with the bronchi, stomach ulcers, encephalitis, disturbances in the functioning of the pancreas, etc.

  • To get rid of the problem or to alleviate it, medication can be used.Prescribed drugs include antipsychotics and antispasmodics. In some cases, inhalation with carbon dioxide is prescribed.

  • If medications do not help, surgery may be the way out: the patient is removed from the branches of the nerve endings leading to the diaphragm.

90,000 British hiccups for 11 years and can’t stop

British Amanda Corby has set a kind of record: she has been suffering from hiccups for 11 years.Attacks overtake her sometimes five times a day throughout all these years. Each individual attack can last 10 minutes, with a 46-year-old woman hiccuping at intervals of two seconds. She has already calculated that she has hiccuped about three million times since 2003, writes the Daily Star.

“I’m tired of being scared and drinking water. All these old tricks don’t work,” complains Amanda. “I tried hypnosis, once it helped me forget about the hiccups for three months. But then it started again. I ran out of ideas about what else can help me. “

Amanda’s fits sometimes amuse her colleagues and visitors to the bingo room where she works. However, the woman herself is already in despair. At first, when the attacks just started, she thought she was eating something wrong. However, no matter what she did, the hiccups did not stop. Amanda is saved only by what she feels when another attack is approaching, so it cannot be said that the hiccups take her by surprise.

After six months of such constant attacks, the woman consulted a doctor. “But the doctor didn’t know what to say.He just suggested that I drink the water in small sips. But where the hiccups come from and how to get rid of it, he did not know “, – recalls Amanda. She was told that the reasons could be hidden both in a gastroenterological disease and in some kind of psychological disorder. Perhaps once the woman experienced severe stress or shock, and these are its consequences.

According to Amanda, she no longer wants to go to doctors and does not believe that medicine can help her. She hopes further hypnosis sessions will help her.However, the woman doubts their effectiveness. “It looks like you’ll just have to live with it,” she says. “I would like to talk to someone who faced the same problem, but I don’t know such people.”

However, Amanda is far from one of those who are tormented by constant hiccups. Emily Marsh, a young British woman, is familiar with her problem. One day, on her way to school, a 13-year-old girl began to hiccup and could not stop for three months. The doctors could not establish the cause of this problem, and then the parents took Emily to a hypnotist.However, all this did not help her.

American Charles Osborne became the “record holder” for the duration of hiccups. Hiccups overtook him for 68 years – from 1922 to 1990. In the 69th year of his life, the hiccups suddenly disappeared. And in 1991 the man died.

90,000 Top 10 causes of hiccups, including deadly ones

Hiccups are generally safe. It is caused by involuntary contractions of the diaphragm , a large muscle that separates the chest and abdominal cavities.

Normally, the diaphragm allows us to breathe. As it moves downward, the ribcage expands and the lungs are able to draw in air. We breathe in. When it rises up, it forces air out of the lungs. Exhalation occurs.

The brain controls the movements of the diaphragm. But sometimes its signals fail, and the diaphragm begins to involuntarily contract. With each spasm, the lungs push air out of themselves, it exits through the larynx and closes the glottis and epiglottis. This process is accompanied by a characteristic sound – hiccups.

Physiologists still do not quite understand why sometimes the brain goes crazy on such a simple movement as inhalation and exhalation. However, it was still possible to establish some factors that can trigger hiccups. Let’s say right away: sometimes hiccups are a dangerous signal.

When you need to see a doctor urgently

Experts of the reputable research organization Mayo Clinic name two symptoms with which you need to see a therapist as soon as possible:

  • hiccups lasting 48 hours or more;
  • The hiccups are shorter, but so tiring that they prevent you from eating, drinking, sleeping or breathing.

An ambulance is not required. Even in the above situations, hiccups by themselves are not fatal. However, it can be a sign of serious diseases that are important to diagnose in time.

Why do people hiccup

Most often, hiccups go away on their own after a few minutes. Such hiccups are called short-term. However, it will be considered short-term even if, with or without interruptions, it lasts up to two days.But if you hiccup for longer, we are talking about long-term or persistent hiccups.

Causes of short-term hiccups

  1. Drinking carbonated drinks.
  2. Overkill with alcohol.
  3. Overeating.
  4. Sudden change in ambient temperature. For example, when you go out of the house to the wind or, conversely, return from the cold to a warm office or apartment.
  5. Eating too hot (optional spicy) or cold food.
  6. Excitement, excitement, fear, stress.
  7. Accidental ingestion of air. This happens when you chew gum or lick lollipops.

Causes of persistent hiccups

Hiccups that last more than two days can be caused by dozens of factors. Not to be listed separately, they are grouped into three categories.

1. Irritation or damage to nerves

We are talking about the vagus or phrenic nerves – those that control the movement of the diaphragm. Damage or irritation can be caused by:

  • Hair, pieces of dirt or other objects (such as small insects) that get caught in the ear and touch the eardrum.
  • Tumor, cyst, goiter in the neck region.
  • Laryngitis. This is the name of inflammation of the mucous membranes of the larynx. Most often it is associated with colds or infectious diseases like measles, whooping cough, scarlet fever.
  • Heartburn. It is also gastroesophageal reflux, in which acidic gastric juice enters the esophagus and irritates its walls.
2. Disorders of the central nervous system (CNS)

Infection, swelling, damage to the central nervous system due to various kinds of injuries – all this can lead to involuntary spasms of the diaphragm.Here are just a few examples of diseases that fall into this category:

  • meningitis;
  • encephalitis;
  • traumatic brain injury;
  • stroke;
  • multiple sclerosis;
  • Brain tumors, both benign and malignant (cancer).
3. Metabolic diseases and taking certain medications

The following factors can provoke persistent hiccups:

  • diabetes;
  • kidney disease;
  • electrolyte imbalance;
  • uncontrolled use of tranquilizers, steroids, barbiturates, pain relievers;
  • alcoholism.

What to do with hiccups

If we are talking about short-term hiccups, then nothing. It will go away by itself in 2-3 minutes. There are ways to shorten this period, Lifehacker wrote about them in detail here. Choose the one you like and go for it.

In case of persistent hiccups, consultation with a therapist is required. The doctor will conduct an examination and, based on the results, will send you to a specialized specialist – for example, an otolaryngologist, to remove a foreign object from the ear or stop developing laryngitis.Or he will prescribe additional tests that will help to get to the bottom of the true causes of hiccups.

Read also 😓🤕🤒

Dog hiccups: causes, preventive measures

Contents of article

Any deviation in the animal’s behavior causes concern to its owner. Hiccuping is one of the common reflexes, which can have various causes and consequences, which are discussed in the article.

Causes of hiccups in dogs

The duration of the hiccupping of an animal can be short-term and long-term. As a rule, short-term hiccups do not pose a danger to the pet.

There are several main reasons that can cause it:

  1. Overeating. Rapid, hasty absorption of food after intense physical exercise or a long active walk leads to the ingress of air into the body, causes a contraction of the diaphragm, which is the cause of the formation of hiccups.
  2. Hypothermia. With poor tolerance to cold climates or the absence of active exercise, the animal may freeze on walks or in an outdoor booth without sufficient insulation.
  3. Active, high-speed games with four-legged friends or with the owner. Usually hiccups are typical for young dogs after rough walking competitions. Such a failure in breathing (jerky contractions of the diaphragm) is attributed to the body’s work to strengthen the muscles of the lungs and stomach.
  4. Fright or stress.Depending on the nature of the pet, its age and habitat, the body’s response to various situations can be different, including the appearance of hiccups. So, in a crowded place or in case of an unusual natural phenomenon, for example, a thunderstorm, the pet may begin to hiccup. In such cases, an affectionate word and slow stroking of the animal will quickly calm it down and stop hiccuping.

In addition to a short period of hiccups, the dog may suffer from long-term hiccups, manifested by attacks.The duration of this uncomfortable period can last from three hours to several days. The reasons for this reaction of the body can be different and more often indicate the following abnormalities in the pet’s body:

  1. Diseases of the gastrointestinal tract. With pathological abnormalities, hiccups in a pet are accompanied by belching and vomiting.
  2. Presence of a foreign body in the stomach.
  3. Prolonged stay of parasites in the dog’s body.
  4. Heart attack.
  5. Disease, disorder of the central nervous system (for example, a consequence of a stroke).
  6. Mechanical injury.

Helping with pet hiccups

When a pet has hiccups, it is recommended:

  1. When overeating, give the dog warm water or a lump of refined sugar, and stroke the belly.
  2. In case of hypothermia, you should check that the resting place is not in a draft or cold floor, you can put a bottle of hot water under the bed or put a pet accustomed to clothes in warm overalls.
  3. To distract the dog from the hiccups, for example, take the two front paws, as if dancing with it, walk for a short time together, which will allow air to escape in the form of a burp and, possibly, stop the hiccups.
  4. A tummy massage for puppies helps to relieve hiccups. The massage should be light and soft, not allowing strong pressure on the tummy.

In case of persistent hiccuping (three or more hours), you should immediately show your pet to a doctor. It is important to understand that long-term hiccups can be a symptom of a heart attack or stroke.

If a foreign body in the stomach is suspected, the pet should be x-rayed.

Based on the results of the examination and the exclusion of serious diseases, the doctor, if necessary, will recommend medications that will help prevent hiccups in the animal.

Preventive measures

In order to prevent attacks of hiccups in a pet, preventive measures must be taken. These include:

  • antihelminthic treatment of the dog once every three months;
  • food temperature control: food should not be hot or too cold;
  • Compliance with the feeding rate: do not overfeed the dog, the amount of food should correspond to the age of the pet;
  • the obligatory availability of water in free access for the dog and its timely replacement with fresh water.

At first glance, hiccups are common. But this is not always the case: only the owner, attentive to the little things, will help the pet to overcome the unpleasant reflex and will try in the future to observe the necessary preventive measures to prevent it.

Interesting topics

90,000 Hiccups Suspected of Positive Influence on Infant Development – Science

LONDON, 13 November. / TASS /. British scientists have suggested that babies need hiccups in order to learn how to breathe properly.This is evidenced by the brain waves that arise in a child’s head during hiccups, the authors said in an article for the scientific journal Clinical Neurophysiology.

Experts have not yet been able to determine the exact reason why we have hiccups. For the first time, it begins in the tenth week of pregnancy and manifests itself until the very old age. Especially often premature babies hiccup – it takes them up to 1% of the time. On average, children spend about 15 minutes a day hiccupping.

“The exact cause of hiccups is not fully understood, but most likely it serves a developmental function. It’s not for nothing that newly born babies hiccup so often,” Kimberly Whitehead, one of the authors of the study, told Sky News.

Neurophysiologists from University College London decided to study the connection between hiccups and electrical activity in the brain of infants. Their study involved 13 infants aged 30 to 42 weeks from conception, that is, both full-term and premature.

The results of the experiment showed that after the contraction of the muscles of the diaphragm during hiccups, several brain waves arise in the brain. Processing these signals can help a baby develop the brain properly, scientists say. In their previous work, they assumed that children pursue a similar goal when they kick in the womb.

“The activity associated with hiccups should help the baby to control his breathing, because it can be caused by the conscious movement of the diaphragm up and down,” – added another author of the work, Lorenzo Fabrizzi.