Hiccups

Hiccup, or singultus, is a spasmodic, involuntary contraction of the inspiratory muscles, associated with delayed, abrupt glottic closure, causing a peculiar sound, expressed by different words around the world. They are  

Hiccup is a forceful, involuntary inspiration commonly experienced by fetuses, children, and adults. Its purpose is unknown, and its pathophysiology still poorly understood. Short hiccup bouts are mostly associated with gastric distention or alcohol intake. They resolve spontaneously or with simple folk remedies and do not require medical attention. In contrast, prolonged hiccup is a rare but disabling condition that can induce depression, weight loss, and sleep deprivation. A wide variety of pathological conditions can cause chronic hiccup myocardial infarction, brain tumor, renal failure, prostate cancer, and abdominal surgery are only a few of these conditions. 

Drugs that have been shown to be effective in treating hiccup are  

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One last form of voltage-mode eontrol is very rudimentary. It eould be ealled hysteretic voltage-mode. In this form of eontrol, a fixed frequency oscillator is gated ON only when the output voltage has fallen to below a limit dictated by the voltage feedback loop. It is sometimes called hiccup-mode because the power switch occasionally bursts on and then returns to a constant off state. 

The power supply enters a hiccup restarting mode of operation during short-eireuits and restarts upon the removal of the short-eireuit. 

Respiratory drive and rhythm are depressed by barbiturates. Coughing, sneezing, hiccupping, and laryngospasm may occur during anesthesia with barbiturates. Sedative ot hypnotic doses of barbiturates teduce heatt tate and blood pressure to levels found in normal sleep. Anesthetic doses produce more pronounced effects. Barbiturates cross the placenta when used in labor, they can cause respiratoty depression in neonates. Anesthetic doses dectease force and frequency of uterine contractions among pregnant women. 

The gum should be chewed slowly, with intermittent parking of the gum at the side of the mouth, to avoid adverse effects (e.g., hiccups, heartburn, stomach upset). Only 50% of the nicotine in a piece of gum is systemically... 

Patients who use the lozenge for smoking cessation should use one lozenge every 1-2 hours for the first 2— weeks, decreasing the interval to every 2-4 hours thereafter. Adverse effects that are common with the nicotine lozenge include heartburn, hiccups, and nausea (Shiffman et al. 2002). Because the product contains phenylalanine, the lozenge should not be used for smoking cessation by individuals with phenylketonuria. 

Aprepitant (Emend) 125 mg on day 1, 1 hour prior to Most common Fatigue, hiccups... 

Intrauterine seizures may occur. The electroencephalogram often displays a hypsarrhythmia or a burst-suppression pattern. Patients display myoclonic jerks, hiccuping and a profound hypotonia. The few patients who survive past the first week usually sustain profound mental retardation and neurological disability. Brain imaging shows atrophy and a loss of myelin. Rarely, patients present later in life with psychomotor retardation and growth failure. Others have had initial normal development followed by a progressive loss of developmental milestones. Some patients have manifested spinocerebellar degeneration and other symptoms of motor dysfunction [27],... 

Drowsiness Gl distress Unsteadiness Hiccups Rash Headache... 

Haloperidol is indicated for schizophrenia, severe anxiety, motor tics and intractable hiccup. It is not indicated in the treatment of parkinsonism, which may be aggravated through its use, as haloperidol tends to cause extra pyramidal symptoms. 

Chlorobutol is a mild hypnotic with analgesic properties, used in seasickness, persistent hiccupping, and irritations due to chronic skin diseases. Dosage 300 to 1,200 mg, mp 77-78°. 

Phenothiazines have a diverse use in medicine. They are primarily used as antipsy-chotics. Despite the fact that they do not cure the disease, they reduce psychotic symptoms to a point where the patient is provided with a better sense of reality. Phenothiazines are sometimes used for relieving severe anxiety, especially in panic attacks caused by dependence on amphetamines or lycergic acid diethylamide (LSD). Phenothiazines are used for alleviating behavioral problems in children that do not respond to treatment of other agents. Phenothiazines are sometimes used during the preoperational period because they relieve anxiety, control nausea, hiccups, diarrhea, and also cause muscle relaxation. 

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

Antipsychotic agents are also used for a diversity of other indications like hiccups, Tourette s syndrome, aggressive behavior in children and the elderly and alcohol withdrawal syndrome. Some of them are also used in anesthesia as they can potentiate the sedative, analgesics or anesthetic effects of other agents. Antipsychotics which are mainly active by blocking dopamine activity have also an effect on chemoreceptor trigger zone and may therefore be used as anti-emetics. 

Fafigue, nausea, hiccups, diarrhea, constipation, anorexia Occasional (8%-4%)... 

Uniabeied Uses Treafmenf of bladder spasms, cerebral palsy, infracfable hiccups or pain, Flunfingfon s chorea, frigeminal neuralgia... 

Contraindications Skelefal muscle spasm due fo cerebral palsy, Parkinson disease, rheumafic disorders, CVA, cough, infracfable hiccups, neuropaf hie pain... 

Mechanism of Action A phenothiazine that blocks dopamine neurotransmission at postsynaptic dopamine receptor sites. Possesses strong anticholinergic, sedative, and antiemetic effects moderate extrapyramidal effects and slight antihistamine action. Therapeutic Effect Relieves nausea and vomiting improves psychotic conditions controls intractable hiccups and porphyria. 

Unlabeled Uses Prevention of aspiration pneumonia treatment of drug-related postoperative nausea and vomiting, persistent hiccups, slow gastric emptying, vascular headaches... 

Decreased respiratory rate, tenderness at IM or IV injection site, pain during injection, oxygen desaturation, hiccups... 

Gum Mouth or throat soreness, nausea, hiccups Transdermal Erythema, pruritus, or burning at application site Occasional... 

The only disadvantages associated with its use are that induction is less smooth, restlessness is more common, as is coughing and hiccup. 

Adverse effects include local effects like redness and phlebitis, apnoea (usually seen on IV administration). Rarely nausea, vomiting, headache, drowsiness, hiccups and retrograde amnesia may occur. 

Adverse effects include blurred or double vision, dizziness, drowsiness, abdominal cramps, confusion, headache, hiccups, anaemia etc. 

Cough and hiccup are uncommon during the administration of thiopentone but laryngeal sensitivity may be increased and secretions/ blood/foreign bodies in the airway may precipitate laryngospasm. There is an increase in bronchial tone although frank bronchospasm is uncommon. 

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