Aetiologies
- Usually unknown (and benign relating to stress and anxiety)
- Postoperative
- Stomach or oesophageal distension
- Gastro-oesophageal reflux
- Diaphragmatic irritation from intrathoracic or an intra-abdominal source
- Chemotherapy
- Associated with CNS disease, alcohol, drugs or metabolic disorders such as uraemia
Assessment
If physical examination of chest and abdomen is normal and the patient has no other associated symptoms, no further investigations are required
Management
- Ice water gargle, or direct stimulation of the posterior pharyngeal wall with a suction catheter or cotton-tipped applicator
- Medication (e.g. metoclopramide 10 mg PO; chlorpromazine 12.5-25 mg IV with 500 mL saline preload; baclofen 5 mg PO QID; lignocaine 2% viscous PO; empirical therapy of gastro-oesophageal reflux with antacid preparations or proton-pump inhibitors)
- Hiccups lasting for more than 24 hours require at least a CXR, FBC, U&E, LFTs, lipase to investigate an underlying organic cause.