050607: Damn Hiccups

Every single one of us has experienced hiccups at least a handful of times. One might wonder what causes this funny, uncomfortable symptom. Hiccups are usually normal and do not indicate serious disease. Let’s look at what causes them and which pathological conditions might present with hiccups (in addition to their other symptoms):

What causes hiccups?

Your diaphragm separates your thorax from your abdomen, being right above the stomach. Anything that irritates the diaphragm will cause it to contract, thus decreasing the pressure in your thoracic cavity further  (the normal pressure is also negative, which is why air flows into your lungs since the pressure outside you is much higher and thus, air flows from a region of high pr

Diaphragm - Muscles of the Upper Extremity Vis...

What conditions could irritate the diaphragm?

Now that you know that any irritation to the diaphragm causes hiccups, let’s look at what could cause that. The structures surrounding it include the stomach and the contents of the thorax. Here’s the list:

  • Over-distension of the stomach (due to large meals, heavy alcohol consumption, fizzy drinks, etc).
  • Acid reflux into the Oesophagus.
  • Any pathology in the thorax, such as pleuritis, pneumonia (at the lower margin of the lungs, which comes into contact with the diaphragm), etc.
  • Direct irritation of the phrenic nerve (the nerve that supplies the diaphragm).
  • Diseases of the central nervous system which affect the brainstem (since the nerve impulses of the phrenic nerve are initiated in the brainstem).
  • Metabolic disorders which result in nervous irritation (such as renal failure, etc).

When are hiccups a problem?

Hiccups become pathological when they are persistent at which point, medical treatment is indicated.

When are hiccups are normal?

Sudden attacks of hiccups for a few minutes in otherwise normal individuals are often observed in the general population. In addition to that, hiccups are seen in foetuses too! They are observed before breathing movements begin and can readily be demonstrated in ultrasounds of human foetuses. They are also considered normal in neonates and usually disappear over a few months of birth.

Treatment options for recurrent hiccups:

After treating any underlying conditions (such as acid reflux,etc), the following medications can be given:

  • Sedatives,
  • Opiates,
  • Antipsychotics (such as chlorpromazine),
  • Levodopa, etc.

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