Fast Five Quiz: Annoying Medical Conditions

Richard H. Sinert, DO


April 25, 2022

Brief episodes of hiccups are a common part of life. Prolonged attacks are a more serious phenomenon and often pose a diagnostic dilemma. These attacks have been associated with significant morbidity and even death. Metabolic causes of hiccups include:

  • Hyponatremia

  • Hypokalemia

  • Hypocalcemia

  • Hyperglycemia

  • Uremia

  • Hypocarbia

Hiccups lasting longer than 48 hours are considered persistent or protracted. Hiccups lasting longer than 1 month are termed intractable. Hiccups that occur during sleep are rare and are probably due to an underlying condition; hiccups during sleep rule out a psychogenic cause.

Many nonpharmacologic remedies are used in the emergency department. Examples include:

  • Stimulation of the nasopharynx by applying forcible traction to the tongue, swallowing granulated sugar, gargling with water, sipping ice water, drinking from the far side of a glass, biting on a lemon, or inhaling noxious agents (eg, ammonia)

  • C3-5 dermatome stimulation by tapping or rubbing the back of the neck, coolant sprays, or acupuncture

  • Direct pharyngeal stimulation by a nasal or oral catheter (as much as 90% effective)

  • Direct uvular stimulation by a spoon or cotton-tip applicator

  • Removal of gastric contents by means of emetics or a nasogastric tube

Learn more about hiccups.


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