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Hiccups (Persistent)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Hiccups, also known as hiccoughs or singultus, are repetitive involuntary spastic contractions of the diaphragm. As the diaphragm contracts, the glottis (opening between the vocal cords) snaps shut to check the inflow of air and makes the distinctive hiccup sound. Distention of the esophagus or stomach with air or food, drinking hot fluids, alcoholic or carbonated beverages, gastroesophageal reflux, and angina pectoris can all cause hiccups.1 Irritation of the phrenic nerves from the neck to the diaphragm, damage to the vagus nerve, and some medications can also cause hiccups.1 Fortunately, hiccups are usually temporary, but some cases can last inordinately long.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Hiccup may exist as an exercise to coordinate respiratory muscles in the fetus but serves no known physiological purpose in the adult. Â 71 The reflex arc consists of Afferent input via the vagus nerve and phrenic nerves and the thoracic sympathetic chainA central mediator thought to be in the cervical spine and brain stemAn efferent limb via motor fibers of the phrenic nerve and intercostal nerves
Sleep, sedation and coma
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
The pattern of the insomnia indicates possible aetiology. Initial insomnia, the inability to fall asleep when desired in the evening, is the most common form of insomnia. Sleep hygiene habits such as a regular bedtime, avoidance of caffeine and fluids over early evening, using bed for sleep and intimacy only (and not TV or reading), mild exercise, and a warm milk drink on retiring may all be upset by the inconveniences of illness. Opportunities to sleep during the day induced by fatigue and boredom also unsettle habitual rhythms. An unfamiliar (hospice) bed, differing temperature, noise and lighting levels all may contribute negatively (or beneficially). Unrelieved symptoms of illness such as pain, dyspnoea, vomiting, itch and diarrhoea are liable to interfere with sleep initiation. Corticosteroid, diuretic, psychostimulant and sympathomimetic medications, and alcohol or benzodiazepine withdrawal states, can disrupt the onset of sleep. Very short-acting hypnotics can result in rebound prior to morning. Akathisia, induced by anti-emetics or antipsychotics, can escalate nocturnally. Hiccups tend to disappear at sleep onset (though they can disrupt its onset) and do not influence established sleep.7 Prolonged bed rest can have a sinister effect on sleep. Lying flat unleashes thoughts (hence the analyst’s couch). Psychological issues often declare themselves in the quiet of night, when visitors have gone home and tiredness encourages reflection and regression. Anxieties and fears during the night, however, present a psychotherapeutic opportunity for the ‘night nurse’. The fear, sometimes the hope, of dying in sleep is prevalent, as is the concern that awakening won’t happen the following morning. These concerns are real for those experiencing dyspnoea. Physiologically, respiration slows with sleep, as the central drive in response to carbon dioxide stimulation is muted, further compromising oxygenation. Total sleep deprivation is less disturbing than partial deprivation, and actually enhances mood. As an antidepressant therapy it is very difficult to enforce for more than a few nights. Sleep rebound consecutive to sleep deprivation produces an analgesic effect similar to that of paracetamol or a NSAID.2
Singultus, paper-bag ventilation, and hypercapnia
Published in Journal of the History of the Neurosciences, 2020
Hiccup (Latin, singultus) is an involuntary, repetitive, and rhythmic contraction of the diaphragm followed by the sudden closure of the glottis. The forcefully inspired air meeting a closed glottis causes the typical hiccup sound. Hiccups lasting less than one day are considered transient, those lasting more are labeled obstinate or persistent. Etiologic classifications are fraught with problems. Hiccup is not a disease, but a symptom. Literally, there is no known disease that has not been associated with hiccups. Although the categories psychogenic, organic, and idiopathic are most commonly used in practice, the situation most commonly encountered is that of hiccup of unknown (idiopathic) origin. In this context, “idiopathic” describes an inability to demonstrate, rather than the absence of, an organic origin (Petroianu 2019).
Spontaneous Improvement of Visual Acuity in a 13-Year-Old Boy with Neuromyelitis Optica Spectrum Disorder
Published in Neuro-Ophthalmology, 2019
Keiko Yamaguchi, Takaaki Hayashi, Akiko Kiriyama, Kie Iida, Shoyo Yoshimine, Yoichiro Masuda, Keigo Shikishima, Mitsuko Ariizumi, Genichiro Takahashi, Tadashi Nakano
In NMO, brain lesions are often observed on MRI images. Furthermore, while cerebral lesions are also found in up to 60% of the adult NMO patients, these are usually clinically silent.9,10 In contrast, a study that examined 58 children with NMO found that 66% of these patients had brain lesions while 68% had clinical symptoms that included hiccups, dizziness, hyponatremia, diabetes insipidus, and menstrual irregularities.6,9 Refractory hiccups and vomiting are common concomitant symptoms, and have been found to be associated with the area postrema.11,12 Typically, these symptoms last for several weeks, and precede other clinical signs. Hiccups were also repeatedly observed in the present case, and may be an early sign of the brain lesion. However, in this case, there were no abnormalities noted in the brain and whole-spine MRI.
Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature
Published in International Journal of Neuroscience, 2018
Sanjeet S. Grewal, Andrea C. Adams, Jamie J. Van Gompel
Hiccups are spasmodic contractions of the diaphragm and the accessory inspiratory muscles. When short lived, hiccups are usually well tolerated. When they become chronic, defined as lasting over 48 hours, they can lead to depression, weight loss, insomnia and exhaustion. Vagal nerve stimulation has been described as a treatment option for chronic intractable hiccups [1,2]. The following study is a case report demonstrating a negative result with vagal nerve stimulation for hiccups and a review of the literature regarding this treatment option.