Persistent Intractable Hiccups

If you have got persistent and intractable hiccups I would like share the latest pharmacological approach with you! The power of a teaspoon of dry sugar to stop hiccups in their tracks has been documented by the New England Journal of Medicine. So take your medicine!

Hiccups are a reflex, a nerve twitch that cycle through your body when something has irritated your diaphragm or one of the vagus nerves that run from the brain to the abdomen. Incidental fun fact; the vagus nerve is what makes us pass out when we have violent stomach illnesses. To cure the hicks, distract yourself with any number of techniques that you’ve probably heard before like get someone to scare you, drink a glass of water from the far side of the glass, hold your breath and count backwards from 100, etc.

Magnesium is a natural muscle relaxer. Hiccups are little more than muscle spasms. Chew on an antacid tablet or two; many of them contain magnesium, and that will break off the jerk cycle and deport the hicks. This one isn’t so helpful if you’re already hiccupping away your afternoon, but being over-full, eating spicy foods, and eating or drinking quickly are roots of hiccups. So please don’t do that!

Take a deep breath and exhale forcefully, visualizing your lungs getting small and tight, and your diaphragm sink all the way down in your abdomen. Visualize the hiccups as a bubble that your diaphragm is trying to pop; like we used to sit on balloons when we were kids. Then inhale and exhale really tiny breaths, not letting up on the abdomen-clenching, bubble-bursting pressure.

Persistent and intractable hiccups are a rather rare, but distressing gastrointestinal symptom found in palliative care patients. Although several recommendations for treatment are given, hiccups often persist. I describe a new pharmacological approach for successfully treating hiccups in four cancer patients. In the first patient, chronic and intractable hiccups lasted for more than 18 months, but left straight away after ingesting a viscous 2 % lidocaine solution for treatment of mucositis. Based on this experience, we successfully treated three further patients suffering from singultus using a lidocaine-containing gel. To the best of my knowledge, this is the first report about managing hiccups by oral application of a lidocaine solution.

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