What are the treatment options for acute hiccups?

Treatment of Acute Hiccups

For acute hiccups, start with simple physical maneuvers and address underlying causes like gastric distention or gastroesophageal reflux; most cases resolve spontaneously within minutes and rarely require medical intervention.

Initial Approach: Physical Maneuvers and Lifestyle Modifications

Simple physical maneuvers that disrupt diaphragmatic rhythm or stimulate the vagus nerve should be attempted first for acute hiccups (lasting less than 48 hours). 1

• Measures that stimulate the uvula or pharynx are simple to use and often help terminate benign, self-limited hiccups 1
• Physical maneuvers that disrupt diaphragmatic (respiratory) rhythm are effective first-line interventions 1
• Larson's maneuver (pulling the tongue forward) can stimulate the vagus nerve or disrupt diaphragmatic rhythm 2
• Avoid alcohol and spicy foods to prevent gastroesophageal reflux, a common trigger of acute hiccups 3

Addressing Common Underlying Causes

Gastric overdistension is the most commonly identifiable cause of acute hiccups, followed by gastroesophageal reflux and gastritis. 4

• Most acute hiccups result from gastric distention or alcohol intake and resolve spontaneously 5
• Treatment should be directed at the underlying cause whenever possible 4
• Bouts of acute hiccups less than 48 hours rarely require medical intervention as they usually resolve within minutes 4

Management of Severe Cases with Respiratory Compromise

For severe acute hiccups causing respiratory distress, escalate to advanced interventions immediately:

• Apply continuous positive airway pressure with 100% oxygen for cases with respiratory compromise 3
• Consider Larson's maneuver (pressure at the "laryngospasm notch") for severe cases with respiratory compromise 3
• Propofol 1-2 mg/kg IV may be needed for persistent cases with oxygen desaturation 3
• Monitor closely for respiratory complications, including potential for respiratory distress or laryngospasm, which can lead to post-obstructive pulmonary edema 3

When to Consider Pharmacotherapy

Pharmacological treatment is generally reserved for hiccups that are bothersome, persistent (>48 hours), or intractable (>2 months). 4

• Acute hiccups less than 48 hours rarely require pharmacological intervention 4
• If symptoms persist beyond 48 hours despite physical maneuvers, consider chlorpromazine 25-50 mg three to four times daily as first-line medication 2, 6
• Chlorpromazine is FDA-approved for intractable hiccups at doses of 25-50 mg t.i.d. or q.i.d., and if symptoms persist for 2-3 days, parenteral therapy is indicated 6
• Monitor for side effects including sedation, hypotension, and extrapyramidal symptoms when using chlorpromazine 2

Common Pitfalls to Avoid

• Do not rush to pharmacotherapy for acute hiccups; most resolve spontaneously and simple maneuvers are often sufficient 4, 5
• Do not overlook gastroesophageal reflux as a treatable underlying cause 4, 7
• Do not ignore respiratory compromise in severe cases; these require immediate escalation of care 3