Hiccup
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| ICD-10 | R06.6 |
|---|---|
| ICD-9 | 786.8 |
A hiccup or hiccough (normally pronounced "HICK-up" (IPA: [ˈhɪ.kʌp]) regardless of spelling) is an involuntary spasm of the diaphragm; typically this repeats several times a minute. The sudden rush of air into the lungs causes the glottis to close, creating the "hic" listen noise. A bout of hiccups generally resolves itself without intervention, although many home remedies are in circulation that claim to shorten the duration, and medication is occasionally necessary. By extension, the term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern. The medical term is singultus.
While many cases develop spontaneously, hiccups are known to develop often in specific situations, such as eating too quickly, taking a cold drink while eating a hot meal, eating very hot or spicy food, laughing vigorously or coughing, drinking an alcoholic beverage to excess, or electrolyte imbalance. Hiccups may be caused by pressure to the phrenic nerve by other anatomical structures, or rarely by tumors and certain kidney disease. It is reported that 30% of chemotherapy patients suffer singultus as a side effect of treatment. (American Cancer Society)
Rare and prolonged cases of hiccups include a man named Charles Osborne who had the hiccups for 69 years, and in January 2007, a St. Petersburg Florida USA girl, Jennifer Mee, contracted hiccups for 5 weeks.
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[edit] Purpose
One possible beneficial effect of hiccups is to dislodge large chunks of food, which have become stuck in the esophagus, or which are traveling too slowly. When a piece of food is swallowed that is too large for the natural peristalsis of the esophagus to move quickly into the stomach, it applies pressure on the phrenic nerve, invoking the hiccup reflex. This causes the diaphragm to contract, creating a vacuum in the thoracic cavity, which creates a region of low pressure on the side of the lump of food nearest the stomach, and a region of high pressure on the side of the lump of food nearest the mouth. This pressure differential across the food creates a force, which assists peristalsis. In humans, gravity partially assists peristalsis, but in quadrupeds and many marine vertebrates, their oesophagi run roughly perpendicular to the force of gravity, so that gravity provides little assistance. The hiccup mechanism likely evolved as an aid to peristalsis in our ancestors. It only now appears to offer little benefit, as humans are upright and gravity assists peristalsis, making it very unlikely for food to become lodged in the esophagus.
Ultrasound scans have also shown that fetuses experience hiccups. Some hypotheses suggest that hiccups are a muscle exercise for the child's respiratory system prior to birth, or that they prevent amniotic fluid from entering the lungs[1]. More research is required to ascertain their true nature, origins, and purpose, if any.
[edit] Home remedies
The following are some commonly suggested home remedies. While numerous remedies are offered, they mostly fall into a few broad categories. These categories include purely psychosomatic cures centered around relaxation and distraction, cures involving swallowing and eating (with the rationale generally that this would remove irritants or reset mechanisms in the affected region), and cures involving controlled/altered breathing.
While the first two categories may prove effective for many short lived and minor cases of hiccups, those suffering from an intractable case may become desperate sorting through various ineffective home remedies. Many of the cures centered around controlled breathing (i.e. holding breath) are often ineffective. The only underlying rationale could be the displacement of an irritated nerve through prolonged diaphragmatic expansion.
However, one respiratory remedy has a fairly sound rationale underlying it. Breathing into a bag or small enclosed container (ensuring that it is completely sealed around the mouth and nose) induces a state that is termed respiratory acidosis. The effect is caused by increasing the amount of inspired carbon dioxide, which then increases the serum level of carbon dioxide. These increased levels of CO2 lower the pH in the blood, hence creating a state of acidosis. This state of acidosis produces vasodilation and depression of the central nervous system. The effect allows for increased blood flow to the affected muscles, and suppression of the aberrant nervous impulses. Inducing a state of acidemia through hyperventilation is particularly effective in curing hiccups because the diaphragm rests directly against the pulmonary vasculature that is then flowing with especially low pH blood. This is a potentially dangerous action; and should only be done with another person present. As the serum CO2 level rises abruptly, the person will begin to feel lightheaded and within a few minutes will pass out. If done without a spotter, the person might either injure him or herself as he or she passes out, or pass out in such a way that the bag or container continues to prevent oxygen intake (see also asphyxia).
Additionally, another respiratory remedy, while having no sound scientific principle behind it, is paradoxically one of the most effective in treating persistent hiccups. One breathes out all the air that they are able to in one long exhalation then breathes in all the air they feel they possibly can in one continuous inhalation. The person then attempts to breathe in even more air in a series of short powerful puffs, until their lungs cannot hold any more. The person remains in this state for as long as they feel they can hold that breath in. Although the success rate is not 100%, many people find this method consistently works.
Psychosomatic
- Distraction from one's hiccup (e.g. being startled or asked a perplexing question)
- Concentration on one's hiccup
- Another distraction based technique is to count in reverse, eg. from 100 down, which requires concentration.
Swallowing
- Swallowing three times while holding one's breath
- Eating particular foods, such as peanut butter, Fluffernutter sandwich, chocolate, sugar or honey, Lingonberry jam, wasabi, vinegar
- Sucking on a lemon wedge coated with 3-4 dashes of Angostura bitters
- Eating a spoonful of granulated table sugar (slowly letting it dissolve in mouth)
- Drinking a glass of water through a napkin placed over the glass
- Drinking a glass of water in several small sips
- Drinking a glass of water "from the wrong side of the glass", i.e. bending over a sink so one's head is upside-down when drinking
- Drinking a glass of water with another's palms against one's ears
- Drinking a glass of a carbonated beverage (with salt) or without, to cause 'burping'.
- Drinking a glass of water than spitting it back up and drinking that again, repeat until hiccups stop.
- Gulping down a glass of water while holding one's breath
- Drinking a glass of water while raising the right or left hand.
- Drinking a glass of water several times successively.
- Swallowing a teaspoon of vinegar in one gulp
- Eating an ice cube
- Drinking a glass of water with a spoon touching one's temple.
- Take a glass of water, and put a spoon in it. Putting the spoon under your tongue, drink as much of the water as you can.
- Drinking a glass of water while plugging ones nose and ears.
Respiratory
- Breathing slowly and deeply in while thinking 'breathing out' and breathing slowly and fully out while thinking 'breathing in'
- Drinking nine gulps of water continuously
- Breathing slowly and deeply in and out through the mouth
- Holding one's breath while optionally squeezing one's stomach
- Breathing deeply through the nose, then exhaling slowly through the mouth
- Exhaling all the air from one's lungs and holding one's breath while swallowing water or saliva
- Blowing up a balloon
- Inducing sneezing
- Breathing into a paper bag or other sealed container. Only attempt this in severe cases of hiccups that have persisted despite other attempts at cures. Perform this sitting or laying down, and with someone at your side to ensure safety. Stop as soon as you begin to feel lightheaded.
- A spoon of vinegar and sugar.
Other
- Sudden shock or alarm. The resulting adrenaline rush will usually cure hiccups; a common cure is to suddenly startle or shout at the sufferer - this only works if they have no idea it's coming.
- In babies, hiccups are usually immediately stopped by the suckling reflex, either by breastfeeding or simply by insertion of a finger, bottle teat or dummy into the baby's mouth.
- For some, throwing up or vomiting the contents in one's stomach.
- By simply waiting until the hiccups subside.
- Injecting adrenaline directly into your circulatory system.
A few people have the ability to stop hiccupping by simply choosing to do so.[citation needed] This brings forward interesting implications regarding voluntary control of various bodily functions.
[edit] Medical treatment
Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them. However, there are a number of anecdotally prescribed treatments for casual cases of hiccups. These include being startled, drinking water while upside down, eating something very sweet or very tart (particularly lemon juice) [2], and anything that interrupts one's breathing. Another method is to exhale air into a small paper bag and to immediately re-inhale that air from it.
Hiccups are treated medically only in severe and persistent (termed "intractable") cases (such as Jennifer Mee, a 15 year old girl who in 2007 hiccuped continuously for five weeks [3]). Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. In severe or resistant cases, baclofen (an anti-spasmodic) is sometimes required to suppress hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating singultus is done short-term, as the affected individual cannot continue with normal life activities while taking the medication.
Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to balance out the potassium-sodium levels in the nervous system. The carbonation promotes quicker absorption.
Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental new procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy. In 2005, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression."[4]
In 2006, Francis Fesmire of the University of Tennessee College of Medicine received an Ig Nobel prize for medicine after he published "Termination of intractable hiccups with digital rectal massage" in 1988.[1] In an attempt to block the runaway messages on the vagus nerve, Fesmire found that stimulation of the vagus nerve by digital rectal massage worked, stopping a bout of hiccupping. Fesmire also commented, "An orgasm results in incredible stimulation of the vagus nerve."[5]
[edit] Footnotes
- ^ Fesmire F. (1988). "Termination of intractable hiccups by digital rectal massage". Ann Emerg Med 17: 872.
[edit] References
- C. Straus, K. Vasilakos, RJA Wilson, et al., A phylogenetic hypothesis for the origin of hiccoughs, In: Bioessays, Vol.25, 2003, S.182-188, Abstract
- Launois et al., Hiccup in adults:an overview, In: European Respiratory Journal, 1993, S.563-575, Abstract
- Davis J. Newsom, An experimental study of hiccup, In: Brain, 1970, Vol.93, S.851-72
- J.S. Jones, T. Lloyd, L. Cannon, Persistent hiccups as an unusual manifestation of hyponatremia, In J. Emerg Med, 1987; 5:283-287
- H.J. Kaufman, Hiccups: causes, mechanisms, and treatment, In: Pract. Gastroenterology, 1985; 9:12-20
- J.H. Lewis, Hiccups: causes and cures, In: J. Clin. Gastroenterology, 1985; 7:539-552
- M.S. Lipsky, Chronic hiccups, In: Am. Fam. Physician, 1986; 34:173-177
- M.D. Nathan, R.T. Leshner, A.P. Keller, Intractable hiccups (singultus), In: Laryngoscope, 1980; 90:1612-1618
- J.V. Souadjian, J.C. Cain, Intractable hiccups: etiologic factors in 220 cases, In: Postgrad Med., 1968; 43:72-77
- M.S. Wagner, J.S. Stapczynski, Persistent hiccups, In: Ann. Emerg. Med., 1982; 11:24-26
