HICCUPS- A TINY SPASM WITH A BIG STORY

MBBS
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My mom used to advise to consume lot of water when I started to have a hiccup.But what if the hiccup not settled after consuming water also? Yes , sometimes it will happen.

Hiccups - refer to spasmodic ,irregular ,intermittent contractions of intercostal muscles and diaphgram against a closed glottis.If the hiccups duration were less than 48 hours - then it is benign ,from 48 hours to 1 month -its persistent and if the duration is more than one month then it is intractable hiccups

Actually there are somany causes for the hiccups and the mechanism involved in hiccups also a complex one.The afferents were vagus,phrenic nerve and sympathetic fibres to central hiccup site - on brainstem and efferent fibres to respiratory and diaphgramatic muscles. The causes were vast which includes ,gastric causes- such as GERD,CNS lesions,CVS- may be a inferior wall MI (better to take ECG - to rule out) , pulmonary embolism ,Aortic dissection,metabolic abnormalities - hypocalcemia,hypercalcemia,hyponatremia,acidosis induced hyperventillation- hypocarbia

So what we can do? Will take all the necessary investigations and treat the cause ah .Actually most of the time ,we will go with presenting complaints,proper examination and history taking ( history of any drug consumptions too - steroids also will cause hiccups) and try to rule out the critical causes and go with very needed investigations such as ECG and CT ( if he shows signs of raised ICT or the history supports it’s need) ,sr.electrolytes to rule out any metabolic abnormalities too

But till then will leave the patient with the hiccups ah ,and what if the investigations also normal.we have certain methods like

1. holding breath for 5 to 10 seconds

2.valsalva maneuver,swallowing sugar,drinking cold water - all targetting vagus nerve

And the first line drugs used in this case is BACLOFEN and GABAPENTIN ,prokinetics like metoclopramide ,chlorpromazine - an approved drug in treatment of intractable hiccups,xylocaine syrup and these were some of the most used and approved drugs.Thus ,hereafter whenever you encounter a patient with hiccups plese remember that hiccups were” A TINY SPASM WITH BIG STORY BEHIND IT”

MBH/PS

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Fantastic explanation, Siddharth! With remarkable clinical depth and clarity, you have discussed hiccups. It is instructive and captivating due to the thorough dissection of causes, mechanisms, and management. The significance is encapsulated in the well-written line, “A tiny spasm with a big story behind it.”

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Very interesting article. There was once a case in our casualty of a 20 year old male who could not stop hicupping since about an hour or so! As you can imagine he was in a lot of pain. There’s also the risk of rupture of the diaphragm if it goes on for too long

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Thank you shreyas

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Very insightful post. The methods of swallowing sugar and drinking cold water were being told to us by our parents and grandparents,but I got to know the reason behind it from here.

Got a chance to explain this scientifically, because I usually ask them scientific explanations for everything they say!!:smiley:

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Brilliantly explained! Dr. Siddharth :clap: You connected the physiology, differential diagnosis, and management beautifully. Loved the line “A tiny spasm with a big story behind it”, catchy and educational.

Just a small suggestion: tightening the flow (from definition → causes → evaluation → management) would make it even more impactful for readers.

Overall, excellent clinical insight and presentation!

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Even a small problem convert in large one.
We have to take care off.
Thankyou dr giving insoght full knowledge as we all have got hiccuos but i dont know the worse and liss can be done by minor problem

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What a crisp and enlightening write‑up! The author skillfully turns something as ordinary as hiccups into a clinical puzzle, reminding us that even “tiny spasms” can hint at serious underlying issues. Their breakdown—from anatomy and neural pathways to diverse causes like metabolic derangements or MI—and then to evaluation and management, is clear and practical. The phrase “a tiny spasm with a big story behind it” resonates deeply: as clinicians, we learn that no symptom is too trivial to explore. It reinforces the habit of listening carefully and investigating thoroughly, even when patients present with the seemingly mundane.

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