HICCUP

Intractable hiccups is a rare but distressing problem. It may be due to phrenic nerve irritation (in the neck or mediastinum), gross hepatomegaly elevating the diaphragm, gastric distention (gas or food), or uremia.

Gas may be relieved by peppermint water (which relaxes the lower esophageal sphincter) or by Mylanta, which has an anti-foaming action.

Metoclopramide 10mg to 20mg 4 times a day is often effective. Chlorpromazine 25mg 2 or 3 times a day is also an effective drug, particularly in uremia. For severe hiccups try chlorpromazine IV 25mg.

Radiotherapy to a large mediastinal tumor may be indicated.

Phrenic nerve interruption is a last resort. The nerve can be crushed in the neck under local anesthetic, or a 5% phenol injection can be given into the neck.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.