A 67‐year‐old man presented to the emergency department with a complaint of a presyncopal episode associated with persistent hiccupping and vomiting for 3 weeks. He also reported decreased oral intake, although he denied early satiety. The patient would vomit after ingesting very small amounts of food. His medical history was notable for right cerebellar stroke with left‐sided hemiparesis and tobacco use. On physical examination, vital signs including orthostatics were normal. The heart, lungs, and abdomen were normal. No new neurologic deficits were found. A noncontrast head CT was normal. Laboratory data showed a WBC count of 14.4 k/cm, hemoglobin 12 g/dL, creatinine 1.5 mg/dL, and BUN 38 mg/dL. Because of the striking nature of his hiccups with associated vomiting, an abdominal CT was obtained, which showed bilateral adrenal gland enlargement (left measuring 5.3 × 2.7 cm, right 4.1 × 2.2 cm), creating concern for metastatic disease or lymphoma. Further radiologic imaging included a PET‐CT scan with findings consistent with metastatic lung cancer. Further evaluation with biopsy was offered. However, given the patient's poor functional status and reluctance to undergo an invasive procedure, the patient elected for discharge with home hospice.
Hiccup, or singulitis, is a sudden contraction of the inspiratory muscles terminated by closure of the glottis. Persistent (greater than 48 hours) and intractable hiccups (greater than 1 month) are an uncommon presenting symptom of CNS lesions, toxic‐metabolic disorders, or abdominal disorders with irritation of the diaphragm or vagus nerve. Other causes include drug, psychogenic, or idiopathic causes. In 1 case series 27% of patients diagnosed with esophageal cancer complained of persistent hiccups, and 9% complained of hiccups as the presenting symptom of their cancer. Medications often used for hiccups include baclofen, gabapentin, metoclopramide, valproic acid, nifedipine, haloperidol, and amitriptyline. Chlorpromazine is the only pharmaceutical FDA‐approved treatment for hiccups. More recently, several case series have suggested that gabapentin is a promising possibility for treating hiccups in the palliative care population.
Hiccups, although nonspecific, may be a presenting symptom of a serious underlying medical condition warranting further investigation. Hospitalists should be aware of the potentially serious diagnosis that can present with hiccups.
D. Stephenson, none.
To cite this abstract:Stephenson D. When Is a Hiccup Not Just a Hiccup?. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 200. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/when-is-a-hiccup-not-just-a-hiccup/. Accessed November 17, 2019.