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Hiccups - Management
How should I assess a person with persistent or protracted hiccups for an underlying cause?
- If hiccups have lasted more than 48 hours, perform a full assessment to assess whether there is an underlying cause.
- Exclude a possible underlying cause based on history and clinical findings. This usually requires referral to secondary care, but baseline investigations that may be considered in primary care include:
- Full blood count (anaemia may indicate gastrointestinal pathology).
- Erythrocyte sedimentation rate or C-reactive protein level (an elevated level suggests the presence of an underlying disease).
- Urea and electrolytes, creatinine (to exclude uraemia, hyponatraemia, hypokalaemia).
- Blood glucose (to exclude hyperglycaemia).
- Liver function tests (abnormal results may indicate hepatitis, liver metastases).
- Serum calcium (to exclude hyper- or hypocalcaemia).
- Electrocardiogram (to exclude pericarditis, recent myocardial infarction).
- Chest radiograph (to exclude lung pathology).
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