Table 21

Investigation and management of hiccups

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsShort-term hiccupsReassure patient.
Long-term hiccupsInvestigate as outlined below.
Medication findings9
  • Corticosteroids

  • Benzodiazepines

  • Barbiturates

  • Opioids

  • Methyldopa

Discuss possible alternative medications.
First line
Routine blood testsInfection with vagal irritation:
  •  ▸ Pleuritis

  •  ▸ Pharyngitis

Treat infection as appropriate.
  •  ▸ Diabetes

  •  ▸ Hypokalaemia

  •  ▸ Hypercalcaemia

  •  ▸ Uraemia

Treat underlying condition.
Physical examinationMeningitisThis is an emergency. Refer immediately to the acute medicine on-call team.
CT chest/abdomenAcute gastric distensionThis is an emergency. Discuss immediately with an upper GI surgeon.
Small bowel obstructionThis is an emergency. Discuss immediately with GI surgeon.
Malignancy/tumour recurrenceDiscuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
Chest pathologyDiscuss with supervising clinician within 24 hours.
Intra-abdominal infectionThis is an emergency. Discuss immediately with the on-call surgical team.
Second line
OGDGORDStart PPI or H2 antagonist. If following oesophagectomy, consider promotility agents (see p. 26).
Third line
If normal investigations/no response to intervention
  • Consider empirical baclofen, PPI, chlorpromazine, haloperidol, gabapentin, pregabalin.

  • Ask for support from palliative care team.

  • Refer to ENT team.

  • Reassure.

  • CT, computerised tomography; ENT, ear, nose and throat; GI, gastrointestinal; GORD, gastro-oesophageal reflux disease; H2, histamine -2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor.