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Ando W, Otsuka Y, Otsuka F. A Case of Persistent Hiccups Induced by an Enlarging Hepatic Cyst Underneath the Diaphragm. Cureus 2024; 16:e58278. [PMID: 38752086 PMCID: PMC11094411 DOI: 10.7759/cureus.58278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/18/2024] Open
Abstract
Although hiccups are regularly self-limited and rarely life-threatening, prolonged hiccups are bothersome, which can significantly decrease the quality of life. Here, we report a case of persistent hiccups coexisting with an enlarging liver cyst situated just below the diaphragm in a patient with autosomal dominant polycystic kidney disease (ADPKD). No other underlying etiologies related to the symptoms were suspected. The cyst was difficult to drain surgically and the patient continued with symptomatic treatment. Although rare, hepatic cysts should be considered a potential cause of prolonged hiccups in patients with ADPKD. We emphasize the significance of systematically excluding potential etiologies that cause prolonged hiccups and considering appropriate therapeutic interventions.
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Affiliation(s)
- Wataru Ando
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
- Center for Graduate Medical Education, Okayama University Hospital, Okayama, JPN
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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2
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Zhou J, Wang F, Li S. Rare case report of moxifloxacin-induced persistent hiccups. Eur J Hosp Pharm 2024; 31:165-167. [PMID: 37369596 PMCID: PMC10895190 DOI: 10.1136/ejhpharm-2023-003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Moxifloxacin is a broad-spectrum antimicrobial agent that is commonly used in clinical practice. Here we report an unusual case of a patient with persistent hiccups caused by moxifloxacin. A man aged in his 40s was treated with moxifloxacin for tuberculous pleurisy. Hiccups occurred 2 hours after intravenous injection of moxifloxacin and lasted into evening. On the second day after injection, hiccups occurred again and made it difficult for him to fall asleep. The clinician ruled out gastrointestinal disease, nervous system disease, electrolyte disturbance and other factors. On assessing causality of the adverse drug reaction, the Naranjo scale for moxifloxacin was six, indicating a probable relationship of hiccups with moxifloxacin. Hiccups stopped 2 min after intramuscular injection of metoclopramide. To our knowledge, this is the first case report about moxifloxacin-induced persistent hiccups. Clinicians should be aware of the rare adverse reaction.
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Affiliation(s)
- Jing Zhou
- Department of Pharmacy, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Wang
- Department of Infectious Disease, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Songlong Li
- Department of Pharmacy, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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3
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Ehret CJ, Martin N, Jatoi A. Baclofen for hiccups: a large mixed methods multisite study. BMJ Support Palliat Care 2024; 13:e1405-e1408. [PMID: 36787986 DOI: 10.1136/spcare-2022-003764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Hiccups can be bothersome and spawn morbidity. Although oral baclofen is perhaps the most prescribed agent for hiccups, a paucity of data supports its use. METHODS This multisite, single institution study examined the medical records of patients who had hiccups and had been prescribed baclofenas noted in a clinical encounter. Mixed methods were used to assess baclofen's palliative efficacy. In view of the sometimes transient nature of hiccups and other such factors, cessation or palliation of hiccups in 75% of patients was sought to indicate true palliation. RESULTS A total of 301 patients with a median age of 61 years (range 20-87 years) and a male predominance are the focus of this report. Baclofen was most often prescribed at 10 mg orally three times a day. Only 105 patients (35%) (95% CI: 30% to 41%) acquired hiccup palliation. Corroborative medical record quotations included, 'Still has hiccups.'Quotations such as, 'Responding to baclofen this AM', were also recorded. Baclofen appeared more likely to benefit patients with hiccups of >48 hours (chronic) duration in univariable analyses (OR for benefit: 0.51 (95% CI: 0.29 to 0.91; p=0.02) with similar conclusions drawn from multivariable analyses. Adverse events occurred in 15 patients with drowsiness the most common. CONCLUSIONS Baclofen did not meet this study's a priori threshold for successful hiccup palliation, but further study is indicated to learn whether baclofen might help patients with chronic hiccups.
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Affiliation(s)
| | - Nichole Martin
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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4
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Wilson E, Lovell N, Richfield E. Hiccups at the End of Life in Parkinson's Disease: A Case Report. J Pain Symptom Manage 2023; 66:e525-e527. [PMID: 37451350 DOI: 10.1016/j.jpainsymman.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Elisabeth Wilson
- Medicine for Older People (E.W., E.R.), North Bristol NHS Trust, Bristol, United Kingdom.
| | - Natasha Lovell
- Specialist Palliative Care (N.L.), North Bristol NHS Trust, Bristol, United Kingdom
| | - Edward Richfield
- Medicine for Older People (E.W., E.R.), North Bristol NHS Trust, Bristol, United Kingdom
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5
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Xausa G, Escher M, Singovski S, Hentsch L. Recurrent Persistent Hiccups on Opioid Treatment: A Case Report and Literature Review. J Pain Palliat Care Pharmacother 2023; 37:82-90. [PMID: 36520149 DOI: 10.1080/15360288.2022.2157070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists concerning the optimal management of the condition. We report on a 64-year-old man diagnosed with advanced renal cancer and painful osteolytic metastases, presenting persistent hiccups while on opioid treatment. Hiccups recurred after multiple challenges with codeine, morphine and hydromorphone on separate occasions. Hiccups ceased only after opioid discontinuation, although various pharmacological treatments were tried to shorten the duration of hiccups. Eventually, fentanyl was introduced and was well tolerated by the patient, without any recurrence of hiccups. The chronological correlation between opioid initiation and the onset of hiccups, as well as opioid discontinuation and the termination of hiccups leads to the conclusion that a causal role of codeine, morphine and hydromorphone in this occurrence is likely. Individual susceptibility probably plays a central role in the development of opioid-related hiccups. Opioid rotation is a promising strategy in the management of opioid-related hiccups, particularly when the mere discontinuation of the opioid is not a viable option, such as in the oncology and palliative care field.
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6
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Hosoya R, Ishii-Nozawa R, Kurosaki K, Uesawa Y. Analysis of Factors Associated with Hiccups Using the FAERS Database. Pharmaceuticals (Basel) 2021; 15:27. [PMID: 35056084 PMCID: PMC8780603 DOI: 10.3390/ph15010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/17/2022] Open
Abstract
In this study, we used the large number of cases in the FDA adverse-event reporting system (FAERS) database to investigate risk factors for drug-induced hiccups and to explore the relationship between hiccups and gender. From 11,810,863 adverse drug reactions reported between the first quarter of 2004 and the first quarter of 2020, we extracted only those in which side effects occurred between the beginning and end of drug administration. Our sample included 1454 adverse reactions for hiccups, with 1159 involving males and 257 involving females (the gender in 38 reports was unknown). We performed univariate analyses of the presence or absence of hiccups for each drug and performed multivariate analysis by adding patient information. The multivariate analysis showed nicotine products to be key suspect drugs for both men and women. For males, the risk factors for hiccups included older age, lower body weight, nicotine, and 14 other drugs. For females, only nicotine and three other drugs were extracted as independent risk factors. Using FAERS, we were thus able to extract new suspect drugs for drug-induced hiccups. Furthermore, this is the first report of a gender-specific analysis of risk factors for hiccups that provides novel insights into drug-induced hiccups, and it suggests that the mechanism responsible is strongly related to gender. Thus, this study can contribute to elucidating the mechanism underlying this phenomenon.
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Affiliation(s)
- Ryuichiro Hosoya
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
- Department of Pharmacy, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonan-cho, Musashino, Tokyo 180-8610, Japan
| | - Reiko Ishii-Nozawa
- Department of Clinical Neuropharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
| | - Kota Kurosaki
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
| | - Yoshihiro Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
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7
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Rao PN, Wu CL, YaDeau JT. Midazolam-Induced Hiccups Reversed by Flumazenil: A Case Report. A A Pract 2021; 15:e01547. [PMID: 34807869 DOI: 10.1213/xaa.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hiccups are a common phenomenon experienced by many people and are usually short-lived with spontaneous resolution of symptoms. Certain anesthetic medications have been associated with the development of hiccups, though the underlying pathophysiology and reflex arcs remain poorly understood. We describe a patient who developed hiccups lasting 9 days following an orthopedic surgery and again developed hiccups during a subsequent surgery after only having received midazolam; flumazenil administration led to sustained cessation of his hiccup symptoms immediately.
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Affiliation(s)
- Prashant N Rao
- From the Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York
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8
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Ergen M, Arikan F, Fırat Çetin R. Hiccups in Cancer Patients Receiving Chemotherapy: A Cross-Sectional Study. J Pain Symptom Manage 2021; 62:e85-e90. [PMID: 33587996 DOI: 10.1016/j.jpainsymman.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Hiccups are a symptom in cancer patients but it's less researched. OBJECTIVES The aimed to determine of prevalence of hiccups and treatment approach used in hiccup management in cancer patients receiving chemotherapy for nursing care. METHODS This study used a descriptive cross-sectional design with self-reported questionnaires and was conducted from November 2018-May 2019 in Turkey. For collection of the data, a Patient Information Form (sociodemographic and disease characteristics), and a Hiccups Evaluation Form were used for the patients. RESULTS Hiccups were observed in 37 (23%) of the 160 patients who met the criteria for inclusion in the study. The great majority of the patients suffering from hiccups were male (65.9%) and the type of cancer in the majority of these patients was gastrointestinal cancer (54.1%). It was determined that the duration of hiccups in 83.8% of patients observed with hiccups was between 0 and 48 hours, that the average severity of their hiccups was 3.81 ± 2.25 (0-10), and that hiccups in 59.5% of these patients was of low severity. It was found that only 10.8% of patients suffering from hiccups used pharmacological methods for relief and that 27% used nonpharmacological methods. CONCLUSION The results of the study showed that over one-fifth of cancer patients suffered from hiccups. This situation reveals that hiccups are an important symptom that needs to be carefully emphasised in oncology practice.
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Affiliation(s)
- Mevlüde Ergen
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Rüya Fırat Çetin
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
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Sene DRD, Watashi DM, Bilitardo IDO, Moreno CEC, Moreno MFDF. COVID-19 presenting as persistent hiccups: a case report. Rev Inst Med Trop Sao Paulo 2021; 63:e62. [PMID: 34378765 PMCID: PMC8357301 DOI: 10.1590/s1678-9946202163062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022] Open
Abstract
Hiccups are involuntary, spasmodic contractions of the diaphragm and intercostal
muscles and can be classified as acute (< 48 h), persistent (48 h to a month)
or intractable (> 1 month). A previously healthy 29-year-old man sought the
Emergency Department with flu-like symptoms and a two-day history of persistent
hiccups. His physical examination was otherwise unremarkable and vital signs
were within normal limits. An unenhanced computed tomography scan of the chest
showed small focal ground-glass opacities scattered throughout 25% of the lungs.
A COVID-19 test was positive. Chlorpromazine was prescribed for the hiccups with
improvement over 10 h. The patient was discharged home on the same day without
hiccups and no other complications.
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Affiliation(s)
- Diogo Ribeiro de Sene
- Hospital Doutor Arnaldo Pezzuti Cavalcanti, Departamento de Medicina Intensiva, Mogi das Cruzes, São Paulo, Brazil
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10
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Patoli D, Chan RCK, Tung A, Rana M. Successful Left Phrenic Nerve Block for Intractable Hiccups in a Patient With LVAD-Induced Diaphragmatic Irritation. J Cardiothorac Vasc Anesth 2021; 36:2544-2547. [PMID: 34598866 DOI: 10.1053/j.jvca.2021.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Daneel Patoli
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
| | - Ronny Cheuk-Kit Chan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Maunak Rana
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
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11
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Ehret C, Young C, Ellefson CJ, Aase LA, Jatoi A. Frequency and Symptomatology of Hiccups in Patients With Cancer: Using an On-Line Medical Community to Better Understand the Patient Experience. Am J Hosp Palliat Care 2021; 39:147-151. [PMID: 33792359 DOI: 10.1177/10499091211006923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer patients are at risk for hiccups, but the incidence and impact on quality of life are unclear. METHODS A survey (modified from the Functional Living Index with the inclusion of qualitative elements) was developed and launched on an 80,000-member medical social media platform, Mayo Clinic Connect https://connect.mayoclinic.org/. RESULTS Among 213 respondents, 34 (16%; 95% CI: 11, 22%) reported "yes" that they had experienced hiccups with cancer therapy. Of those patients who reported hiccups, only 12 (35%) were men, and most were older than 50 years of age. Over 25% noted that hiccups occurred frequently around the time of cancer therapy; 30% described that hiccups interfered with their leisure or recreational activities; and over 15% described hiccups interfered with their ability to enjoy a meal. A few patients seemed to express frustration with hiccups with comments such as, "Totally uncontrollable," "It's extremely pain[ful] with throat cancer," and "Once I had them bad. Almost choked." CONCLUSION Hiccups occur in16% of patients who are receiving cancer therapy and, by our estimates and extrapolation, appear highly problematic in approximately 5%.
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Affiliation(s)
| | - Colleen Young
- Mayo Clinic Connect, Mayo Clinic, Rochester, MN, USA
| | | | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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12
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Zhang Y, Jiang X, Wang Z, He M, Lv Z, Yuan Q, Qin W. Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24879. [PMID: 33663115 PMCID: PMC7909209 DOI: 10.1097/md.0000000000024879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups. METHODS AND ANALYSIS Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the "risk of bias" assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups. CONCLUSIONS This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER CRD42020114900.
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Affiliation(s)
- Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Xudong Jiang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Zhijie Wang
- Shanxi Province Hospital of Traditional Chinese Medical, Taiyuan
| | - Mingming He
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
| | - Zimeng Lv
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Qing Yuan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weixun Qin
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
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13
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Egbu E, Ihemedu C, Eze UA, Nwajei C, Ikponmwosa M. Steroid-Induced Hiccups in a Patient Managed for Pseudo Foster-Kennedy Syndrome: A Case Report of Good Outcome With the use of Gabapentin. Cureus 2021; 13:e12893. [PMID: 33643737 PMCID: PMC7903257 DOI: 10.7759/cureus.12893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of IV methylprednisolone has been shown to be associated with some adverse effects. The most feared side effect is acute gastrointestinal perforation and accelerated hypertension particularly during pulse therapy. Hiccups occur less frequently but can cause high levels of discomfort to the patient. In intractable cases, respiratory arrest and death can occur. This article reports the occurrence of hiccups in a patient managed for pseudo Foster-Kennedy syndrome. The hiccups were observed shortly after IV methylprednisolone was administered to the patient and abetted over a period of one week after it was discontinued. Hiccups occur through the neuronal pathway of the hiccup reflex arc, comprising the vagus nerve, phrenic nerve, parts of the sympathetic nervous system (T6-T12), and efferent fibers from the phrenic nerve that supply the glottis and the accessory muscles of respiration. The hiccups resolved with the use of gabapentin. This case report aims to add to the existing body of knowledge of the efficacy of gabapentin in the management of hiccups.
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Affiliation(s)
- Ejike Egbu
- Ophthalmology, Lily Hospitals Limited, Warri, NGA
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14
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Nguyen V, Deeb K, Rathakrishnan R. Hiccups: You got to be kidney me! SAGE Open Med Case Rep 2020; 8:2050313X20962641. [PMID: 33062282 PMCID: PMC7533925 DOI: 10.1177/2050313x20962641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022] Open
Abstract
Hiccups are usually benign processes that most people experience with spontaneous resolution. However, persistent hiccups with a duration greater than 48 h may prompt a thorough workup for structural, infectious, or inflammatory disorders. Moreover, toxic-metabolic states, including renal dysfunction and/or uremia, have also been identified as sources of hiccups. We present a 62-year-old male with persistent hiccups that developed acute, worsening renal function. Workup for a possible intrinsic renal disease process was negative. Ultimately, a kidney biopsy was performed, demonstrating acute tubular injury with oxalate crystals and interstitial fibrosis. Dialysis was initiated with resolution of the hiccups, and kidney function improved over an extended period of time.
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Affiliation(s)
- Viva Nguyen
- Internal Medicine Resident, University of Miami JFK GME, Atlantis, FL, USA
| | - Khaled Deeb
- Internal Medicine Resident, University of Miami JFK GME, Atlantis, FL, USA
| | - Ranga Rathakrishnan
- Department of Internal Medicine, Hospitalist, West Palm Beach Veterans Affairs Medical Center, West Palm Beach, FL, USA
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15
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Persistent Postoperative Hiccups. Case Rep Anesthesiol 2020; 2020:8867431. [PMID: 32695523 PMCID: PMC7355363 DOI: 10.1155/2020/8867431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/16/2023] Open
Abstract
Hiccups are a common and poorly understood pathologic phenomenon. While hiccups often occur suddenly and episodically, they may persist for weeks and sometimes months. There is a paucity of data regarding the precise etiology and optimal treatment for persistent hiccups. Frequently considered a benign and frustrating condition, hiccups are sometimes a presenting symptom for pulmonary embolism and cardiac disease. We present a patient with gastroesophageal reflux disease who developed 11 days of recurrent hiccups following an orthopedic procedure.
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16
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Squires M, Sribnick EA. An Investigation of Hiccups. Pediatr Neurol 2020; 106:70-71. [PMID: 32139168 DOI: 10.1016/j.pediatrneurol.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa Squires
- Department of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Eric A Sribnick
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
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17
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Prommer E. Midazolam: an essential palliative care drug. Palliat Care Soc Pract 2020; 14:2632352419895527. [PMID: 32215374 PMCID: PMC7065504 DOI: 10.1177/2632352419895527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022] Open
Abstract
Midazolam is a commonly used benzodiazepine in palliative care and is considered one of the four essential drugs needed for the promotion of quality care in dying patients. Acting on the benzodiazepine receptor, it promotes the action of gamma-aminobutyric acid. Gamma-aminobutyric acid action promotes sedative, anxiolytic, and anticonvulsant properties. Midazolam has a faster onset and shorter duration of action than other benzodiazepines such as diazepam and lorazepam lending itself to greater flexibility in dosing than other benzodiazepines. The kidneys excrete midazolam and its active metabolite. Metabolism occurs in the liver by the P450 system. This article examines the pharmacology, pharmacodynamics, and clinical uses of midazolam in palliative care.
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Affiliation(s)
- Eric Prommer
- UCLA/VA Hospice and Palliative Medicine Program, UCLA School of Medicine, 11301 Wilshire Blvd., Bldg. 500, Room 2064A, Los Angeles, CA 90073, USA
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Li XB, Wu DJ, Yang MC. Acupuncture for hiccups: A systematic review protocol of high-quality randomized trials. Medicine (Baltimore) 2019; 98:e18343. [PMID: 31860989 PMCID: PMC6940168 DOI: 10.1097/md.0000000000018343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A Hiccup is a common disease that often occurs along with other chronic or acute conditions. At present, there is a lack of feasible therapies for hiccups, and acupuncture is a treatment method with enormous clinical practice worldwide. METHODS Based on a pre-defined search strategy, we searched seven databases and screened them by two independent investigators, without language and publication status restriction from inception to date. We use the pre-set form to incorporate data and utilize Revman software to synthesize data. We will evaluate the risk of bias in the inclusion of the study based on the Cochrane 'Risk of bias' assessment tool. The quality of the evidence will be evaluated according to the GRADEpro software. RESULTS This systematic review will evaluate the efficacy and safety of acupuncture treatment for hiccups. The entire process will be referred to the Cochrane handbook recommended by the Cochrane Collaboration. CONCLUSION This review will provide systematic evidence to summarize whether acupuncture is an effective intervention in the treatment of hiccup.
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Affiliation(s)
- Xiao-Bing Li
- Department of Gastroenterology, The First People's Hospital of Pinghu City, Jiaxing
| | - Dong-Jie Wu
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
| | - Min-Chun Yang
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
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Bahadoori A, Shafa A, Ayoub T. Comparison the Effects of Ephedrine and Lidocaine in Treatment of Intraoperative Hiccups in Gynecologic Surgery under Sedation. Adv Biomed Res 2019; 7:146. [PMID: 30596056 PMCID: PMC6282478 DOI: 10.4103/abr.abr_82_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation. Materials and Methods: This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery. Results: Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups. Conclusion: Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.
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Affiliation(s)
- Azadeh Bahadoori
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Shafa
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Taha Ayoub
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Grewal SS, Adams AC, Van Gompel JJ. Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature. Int J Neurosci 2018; 128:1114-1117. [DOI: 10.1080/00207454.2018.1486307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sanjeet S. Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
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