snippet from
eMedicine - Hiccups : Article by Garry Wilkes
Typical causes include gastric distention (ie, food, alcohol, air), sudden changes in ambient or gastric temperature, and use of alcohol and/or tobacco in excess. Psychogenic causes (ie, excitement, stress) also may elicit hiccups.
Persistent or intractable episodes are more likely to result from serious pathophysiological processes affecting a component of the hiccup reflex mechanism. More than 100 causes have been described; however, in many cases, the cause remains idiopathic. These may be classified as follows:
* Eighty-two percent of persistent or intractable episodes occur in men. An organic cause can be identified in 93% of men and in 8% of women, resulting in an overall organic incidence of 80%. The remaining 20% are considered psychogenic in origin.
*
o Hysteria
o Shock
o Fear
o Personality disorders
o Conversion disorders
o Malingering
* Central nervous system
*
o Structural - Malignancies, multiple sclerosis
o Vascular lesions
o Infection
o Trauma
* Diaphragmatic irritation
*
o MI
o Pericarditis
o Hiatal hernia
o Subphrenic abscess
* Vagus nerve irritation
*
o Meningeal branches - Meningitis, glaucoma
o Auricular branches - Foreign body, hairs
o Pharyngeal branches - Pharyngitis
o Recurrent laryngeal nerve - Mass lesions in neck, goiter
o Thoracic branches - Infection, tumors, esophagitis (ie, reflux), MI, asthma, trauma, thoracic aortic aneurysm
o Abdominal branches - Tumors, gastric distension, peptic ulcer, AAA, infection, organ enlargement, inflammation (eg, appendicitis, cholecystitis, inflammatory bowel disease)
* Anesthesia related
*
o Hyperextension of neck - Stretching phrenic nerve roots
o Manipulation of diaphragm or stomach
o Laparotomy
o Thoracotomy
o Craniotomy
* Metabolic
*
o Hyponatremia
o Hypokalemia
o Hypocalcemia
o Hyperglycemia
o Uremia
o Hypocarbia
o Fever
* Drugs
*
o Benzodiazepines
o Short-acting barbiturates
o Dexamethasone
o Alpha methyldopa