Diferencia entre revisiones de «Hiccups»
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==Background== | ==Background== | ||
*Usually initiated by gastric distention from food, carbonated beverage, or air | *Usually initiated by gastric distention from food, carbonated beverage, or air | ||
*Also known as Singultus | *Also known as Singultus | ||
===Definitions=== | ===Definitions=== | ||
*Hiccup bout: | |||
*Hiccup bout: <48 hours | |||
*Persistent hiccups: 48 hours to 1 month | *Persistent hiccups: 48 hours to 1 month | ||
*Intractable hiccups: >1 month | *Intractable hiccups: >1 month | ||
==Clinical Features== | ==Clinical Features== | ||
*Hiccups | *Hiccups | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Hiccups=== | ===Hiccups=== | ||
*Central nervous system disorders | *Central nervous system disorders | ||
**Vascular | **Vascular | ||
***Ischemic/hemorrhagic [[stroke]] | ***Ischemic/hemorrhagic [[Special:MyLanguage/stroke|stroke]] | ||
***AV malformations | ***AV malformations | ||
***[[Temporal arteritis]] | ***[[Special:MyLanguage/Temporal arteritis|Temporal arteritis]] | ||
**Infections | **Infections | ||
***[[Encephalitis]] | ***[[Special:MyLanguage/Encephalitis|Encephalitis]] | ||
***[[Meningitis]] | ***[[Special:MyLanguage/Meningitis|Meningitis]] | ||
***[[Brain abscess]] | ***[[Special:MyLanguage/Brain abscess|Brain abscess]] | ||
***[[ | ***[[Special:MyLanguage/Neurosyphilis|Neurosyphilis]] | ||
***Subphrenic abscess | ***Subphrenic abscess | ||
**Structural | **Structural | ||
***[[Head trauma]] | ***[[Special:MyLanguage/Head trauma|Head trauma]] | ||
***[[Intracranial neoplasm]] | ***[[Special:MyLanguage/Intracranial neoplasm|Intracranial neoplasm]] | ||
***Brainstem neoplasms | ***Brainstem neoplasms | ||
***[[Multiple sclerosis]] | ***[[Special:MyLanguage/Multiple sclerosis|Multiple sclerosis]] | ||
***Syringomyelia | ***[[Special:MyLanguage/Syringomyelia|Syringomyelia]] | ||
***Hydrocephalus | ***[[Special:MyLanguage/Hydrocephalus|Hydrocephalus]] | ||
**Vagus and phrenic nerve irritation | **Vagus and phrenic nerve irritation | ||
***Goiter | ***[[Special:MyLanguage/thyroid disease|Goiter]] | ||
***[[Pharyngitis]] | ***[[Special:MyLanguage/Pharyngitis|Pharyngitis]] | ||
***[[Laryngitis]] | ***[[Special:MyLanguage/Laryngitis|Laryngitis]] | ||
***Hair or foreign body irritation of tympanic membrane | ***Hair or foreign body irritation of tympanic membrane | ||
***Neck cyst or other tumor | ***Neck cyst or other tumor | ||
*Gastrointestinal disorders | *Gastrointestinal disorders | ||
**Gastric distention | **Gastric distention | ||
**[[Gastritis]] | **[[Special:MyLanguage/Gastritis|Gastritis]] | ||
**[[Peptic ulcer disease]] | **[[Special:MyLanguage/Peptic ulcer disease|Peptic ulcer disease]] | ||
**[[Pancreatitis]] | **[[Special:MyLanguage/Pancreatitis|Pancreatitis]] | ||
**Pancreatic cancer | **Pancreatic cancer | ||
**Gastric carcinoma | **Gastric carcinoma | ||
**Abdominal abscesses | **Abdominal abscesses | ||
**[[Gallbladder disease]] | **[[Special:MyLanguage/Gallbladder disease|Gallbladder disease]] | ||
**[[Inflammatory bowel disease]] | **[[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]] | ||
**[[Hepatitis]] | **[[Special:MyLanguage/Hepatitis|Hepatitis]] | ||
**Aerophagia | **Aerophagia | ||
** | **Esophageal distention | ||
**[[Esophagitis]] | **[[Special:MyLanguage/Esophagitis|Esophagitis]] | ||
**[[Bowel obstruction]] | **[[Special:MyLanguage/Bowel obstruction|Bowel obstruction]] | ||
*Thoracic disorders | *Thoracic disorders | ||
**Enlarged lymph nodes secondary to infection or neoplasm | **Enlarged lymph nodes secondary to infection or neoplasm | ||
**[[Pneumonia]] | **[[Special:MyLanguage/Pneumonia|Pneumonia]] | ||
**[[Empyema]] | **[[Special:MyLanguage/Empyema|Empyema]] | ||
**[[Bronchitis]] | **[[Special:MyLanguage/Bronchitis|Bronchitis]] | ||
**[[Asthma]] | **[[Special:MyLanguage/Asthma|Asthma]] | ||
**[[Pleuritis]] | **[[Special:MyLanguage/Pleuritis|Pleuritis]] | ||
**[[Nontraumatic thoracic aortic dissection|Aortic | **[[Special:MyLanguage/Nontraumatic thoracic aortic dissection|Aortic dissection]] | ||
**[[Mediastinitis]] | **[[Special:MyLanguage/Mediastinitis|Mediastinitis]] | ||
**Mediastinal tumors | **Mediastinal tumors | ||
**[[Chest trauma]] | **[[Special:MyLanguage/Chest trauma|Chest trauma]] | ||
**[[Pulmonary embolism ]] | **[[Special:MyLanguage/Pulmonary embolism |Pulmonary embolism ]] | ||
*Cardiovascular disorders | *Cardiovascular disorders | ||
**[[Myocardial infarction]] | **[[Special:MyLanguage/Myocardial infarction|Myocardial infarction]] | ||
**[[Pericarditis]] | **[[Special:MyLanguage/Pericarditis|Pericarditis]] | ||
*Toxic-metabolic | *Toxic-metabolic | ||
**[[Alcohol intoxication]] | **[[Special:MyLanguage/Alcohol intoxication|Alcohol intoxication]] | ||
**[[Diabetes mellitus]] | **[[Special:MyLanguage/Diabetes mellitus|Diabetes mellitus]] | ||
**[[Herpes zoster]] | **[[Special:MyLanguage/Herpes zoster|Herpes zoster]] | ||
**[[Hypocalcemia]] | **[[Special:MyLanguage/Hypocalcemia|Hypocalcemia]] | ||
**[[Hypocapnia]] | **[[Special:MyLanguage/Hypocapnia|Hypocapnia]] | ||
**[[Hyponatremia]] | **[[Special:MyLanguage/Hyponatremia|Hyponatremia]] | ||
**[[Influenza]] | **[[Special:MyLanguage/Influenza|Influenza]] | ||
**[[Malaria]] | **[[Special:MyLanguage/Malaria|Malaria]] | ||
**[[Tuberculosis]] | **[[Special:MyLanguage/Tuberculosis|Tuberculosis]] | ||
**[[Uremia]] | **[[Special:MyLanguage/Uremia|Uremia]] | ||
*Postoperative | *Postoperative | ||
**General anesthesia | **General anesthesia | ||
**[[Intubation]] (stimulation of glottis) | **[[Special:MyLanguage/Intubation|Intubation]] (stimulation of glottis) | ||
**Neck extension (stretching phrenic nerve roots) | **Neck extension (stretching phrenic nerve roots) | ||
**Gastric distention | **Gastric distention | ||
| Línea 86: | Línea 98: | ||
*Drugs | *Drugs | ||
**Alpha methyldopa | **Alpha methyldopa | ||
**Short-acting [[ | **Short-acting [[Special:MyLanguage/barbiturates|barbiturates]] | ||
**Chemotherapeutic agents (eg, carboplatin) | **Chemotherapeutic agents (eg, carboplatin) | ||
**[[Dexamethasone]] | **[[Special:MyLanguage/Dexamethasone|Dexamethasone]] | ||
**[[Diazepam]] | **[[Special:MyLanguage/Diazepam|Diazepam]] | ||
*Psychogenic | *Psychogenic | ||
**[[Anorexia nervosa]] | **[[Special:MyLanguage/Anorexia nervosa|Anorexia nervosa]] | ||
**[[Conversion reaction]] | **[[Special:MyLanguage/Conversion reaction|Conversion reaction]] | ||
**Excitement | **Excitement | ||
** | **Malingering | ||
**[[Schizophrenia]] | **[[Special:MyLanguage/Schizophrenia|Schizophrenia]] | ||
**Stress | **Stress | ||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Consider auditory canal exam (foreign body against TM can trigger hiccups) | *Consider auditory canal exam (foreign body against TM can trigger hiccups) | ||
*[[Hyponatremia]] and | *Consider [[Special:MyLanguage/Hyponatremia|Hyponatremia]] and [[Special:MyLanguage/Hypocalcemia|Hypocalcemia]] | ||
*Consider CXR | *Consider [[Special:MyLanguage/CXR|CXR]] | ||
==Management== | ==Management== | ||
*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc) | *Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc) | ||
**Remove foreign body from ear | **Remove [[Special:MyLanguage/ear foreign body|foreign body]] from ear | ||
**Swallow teaspoon of sugar | **Swallow teaspoon of sugar | ||
**Sip ice water | **Sip ice water | ||
**Drink water quickly | **Drink water quickly | ||
*Meds | *Meds | ||
**[[Chlorpromazine]] 25–50mg IV; 25–50mg PO TID | **[[Special:MyLanguage/Chlorpromazine|Chlorpromazine]] 25–50mg IV; 25–50mg PO TID | ||
**[[Metoclopramide]] 10mg IV or IM; 10–20mg PO TID x 10d | **[[Special:MyLanguage/Metoclopramide|Metoclopramide]] 10mg IV or IM; 10–20mg PO TID x 10d | ||
**Initiating pharmacologic treatment with a [[Special:MyLanguage/proton pump inhibitor|proton pump inhibitor]]. Alternative first-line agents include [[Special:MyLanguage/baclofen|baclofen]], [[Special:MyLanguage/gabapentin|gabapentin]], and [[Special:MyLanguage/metoclopramide|metoclopramide]]<ref>Lembo et al. Hiccups. Uptodate.https://www.uptodate.com/contents/hiccups?search=Hiccups&source=search_result&selectedTitle=1~41&usage_type=default&display_rank=1#H1014341651 </ref> | |||
==Disposition== | ==Disposition== | ||
*Discharge for uncomplicated hiccups | *Discharge for uncomplicated hiccups | ||
==See Also== | ==See Also== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[category:Symptoms]] | |||
</translate> | |||
Revisión actual - 23:05 4 ene 2026
Background
- Usually initiated by gastric distention from food, carbonated beverage, or air
- Also known as Singultus
Definitions
- Hiccup bout: <48 hours
- Persistent hiccups: 48 hours to 1 month
- Intractable hiccups: >1 month
Clinical Features
- Hiccups
Differential Diagnosis
Hiccups
- Central nervous system disorders
- Vascular
- Ischemic/hemorrhagic stroke
- AV malformations
- Temporal arteritis
- Infections
- Encephalitis
- Meningitis
- Brain abscess
- Neurosyphilis
- Subphrenic abscess
- Structural
- Head trauma
- Intracranial neoplasm
- Brainstem neoplasms
- Multiple sclerosis
- Syringomyelia
- Hydrocephalus
- Vagus and phrenic nerve irritation
- Goiter
- Pharyngitis
- Laryngitis
- Hair or foreign body irritation of tympanic membrane
- Neck cyst or other tumor
- Vascular
- Gastrointestinal disorders
- Gastric distention
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Pancreatic cancer
- Gastric carcinoma
- Abdominal abscesses
- Gallbladder disease
- Inflammatory bowel disease
- Hepatitis
- Aerophagia
- Esophageal distention
- Esophagitis
- Bowel obstruction
- Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm
- Pneumonia
- Empyema
- Bronchitis
- Asthma
- Pleuritis
- Aortic dissection
- Mediastinitis
- Mediastinal tumors
- Chest trauma
- Pulmonary embolism
- Cardiovascular disorders
- Toxic-metabolic
- Postoperative
- General anesthesia
- Intubation (stimulation of glottis)
- Neck extension (stretching phrenic nerve roots)
- Gastric distention
- Traction on viscera
- Drugs
- Alpha methyldopa
- Short-acting barbiturates
- Chemotherapeutic agents (eg, carboplatin)
- Dexamethasone
- Diazepam
- Psychogenic
- Anorexia nervosa
- Conversion reaction
- Excitement
- Malingering
- Schizophrenia
- Stress
Evaluation
- Clinical diagnosis
- Consider auditory canal exam (foreign body against TM can trigger hiccups)
- Consider Hyponatremia and Hypocalcemia
- Consider CXR
Management
- Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
- Remove foreign body from ear
- Swallow teaspoon of sugar
- Sip ice water
- Drink water quickly
- Meds
- Chlorpromazine 25–50mg IV; 25–50mg PO TID
- Metoclopramide 10mg IV or IM; 10–20mg PO TID x 10d
- Initiating pharmacologic treatment with a proton pump inhibitor. Alternative first-line agents include baclofen, gabapentin, and metoclopramide[1]
Disposition
- Discharge for uncomplicated hiccups