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Hiccups

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Multiple drug and non-drug methods have been used to disrupt the hiccup reflex arc. When a patient's hiccups are protracted, home remedies are generally ineffective and other means must be employed.1 One non-drug method uses a nasogastric (NG) tube. Insert the NG tube into the stomach and immediately remove it. The hiccups should stop at once. If not, try a second time. It's postulated that the mechanism involved is irritation of the posterior nasal mucous membrane and lower esophageal sphincter.2

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Another method of treating hiccups that is relatively benign, generally available, inexpensive, and simple to use is intravenous (IV) lidocaine. On multiple occasions, it has worked successfully when other medications have failed. Reported successful procedures with lidocaine doses, in both children and adults, have involved loading the patient with 1 to 2 mg/kg and then generally beginning a 2 mg/kg (sometimes up to 4 mg/kg) drip for 4 to 12 hours. This often had to be repeated within 24 hours.3-6 My personal experience with this technique was in a remote location with an adult who had had several severe and debilitating hiccup attacks over the prior decade. I used an infusion of 2 mg/kg lidocaine over 20 minutes, which stopped the hiccups as the infusion was ending. Although they did not recur, I gave him a 20-minute infusion of 1 mg/kg on each of the next 2 days. He did not have a recurrence over the next 5 months.

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Nausea and Vomiting

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Treatments for the common complaint of nausea and vomiting vary around the globe. Some medications, such as the phenothiazines that are commonly used in some countries, are unavailable for this use in other countries. Other common treatments, such as metoclopramide and ginger root, are ineffective.7

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Some generally available and inexpensive medications that have been shown to be effective for nausea and vomiting include dexamethasone, 5 to 10 mg IV (pediatric dose: 0.5 to 1.5 mg/kg); droperidol, 0.625 to 1.25 mg IV; dimenhydrinate, 1 to 2 mg/kg IV; and ephedrine, 0.5 mg/kg intramuscularly (IM).8 A side benefit of using dexamethasone is that it often relieves bowel obstruction along with the accompanying nausea and vomiting in cancer patients.9

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Acupressure, as both a preventive (anesthesia and pregnancy) and a treatment, has shown mixed results. Acupressure may be more effective in controlling nausea symptoms than in preventing emesis.10 But, since it costs nothing, has no side effects, is simple to use, and is available in any situation, it is probably worth trying. The Pe6 Neiguan point where acupressure is applied can be located on the volar forearm about 2 inches proximal to the distal wrist crease (in adult males) between the tendons of the flexor carpi radialis and palmaris longus. For others, it is one-sixth the distance between the distal wrist crease and the elbow flexor crease (Fig. 31-1). ...

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