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Hiccup (singultis) is usually a transient, innocuous symptom, but when persistent it may become an exhausting and disabling problem. Intractable hiccup has been attributed to a host of metabolic, peridiaphragmatic, neurologic, and psychogenic conditions, but many cases do not have a known cause.


No useful function has been found for the hiccup, which occurs as a result of synchronous clonic spasm of intercostal muscles and diaphragm that causes sudden inspiration followed by prompt closure of the glottis and inhibition of respiratory activity. It is believed to be a reflex.

During the hiccup, the glottis is closed. The classic explanation is that it is due to stimulation.


Persistent hiccup that proves refractory to simple measures is an indication for further investigation. Extensive workup is usually not productive, but a check for a previously unsuspected metabolic.


Questioning should include inquiry into recent abdominal, thoracic, or neurologic surgery, abdominal pain (especially that which radiates to the tip of the shoulder or is worsened by respiration).

For patients with self-limited causes of hiccuping, several home remedies are capable of interrupting the reflex arc; others simply suppress it temporarily. Breath holding and breathing into a paper bag will decrease the frequency of hiccups, but, if the underlying stimulus has not disappeared, they usually return after these maneuvers are terminated. Swallowing a teaspoonful of granulated sugar works by irritating the pharynx sufficiently to inhibit further hiccuping. A more noxious maneuver.

When symptoms are persistent and the cause remains undiagnosed or untreatable, symptomatic relief becomes an important goal. Chlorpromazine in doses of 25 to 50 mg intravenously will often terminate.