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Hiccups (singultus), an involuntary diaphragmatic spasm with a sudden closure of the glottis, is considered persistent when it lasts more than 48 hours. Its etiology can be organic, psychogenic, or idiopathic. Usually, the initial problem is to stop the hiccups, even if an organic cause is being investigated. In austere settings, some of the safer non-pharmacological remedies (Table 34-1) may be the most helpful. One of the most interesting is continuous tapping, usually for a few minutes, over the C5 vertebra until the hiccups cease. Another is self-compression of the chest by either pulling one’s knees to one’s chest or leaning forward. While some of these methods have a sound physiological base, their effectiveness is uncertain, especially with protracted hiccups.

TABLE 34-1Non-drug Treatments for Hiccups and Their Proposed Physiological Bases

Multiple drugs have also been successfully used. If hiccups persist, prescribe chlorpromazine (Thorazine) 25 to 50 mg orally three or four times a day. Haloperidol, 2 to 5 mg intramuscularly (IM), is a safer and possibly more successful alternative. If it works, prescribe 1 to 4 mg orally three times a day. Other drugs used for hiccup treatment include many anticonvulsants (e.g., phenytoin, phenobarbital, carbamazepime, valproic acid), benzodiazepines, metoclopramide, various sedatives, and narcotics.2

Another method of treating hiccups that is relatively benign, generally available, inexpensive, and simple to use is 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.3,4,5,6 My personal experience with this technique was in a remote location with an adult who had had several severe and debilitating hiccup ...

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