Hiccups, a rare complication arising from use of a central venous catheter

Sav, Tansu

doi:10.1111/j.1542-4758.2010.00458.x

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…Because the right phrenic nerve is a branch of cervical plexus with close contact to the right atrium, atrial pacing for brady-arrhythmia and catheter ablation for atrial fibrillation were reported to induce diaphragmatic contractions and hiccups 53,54. Similar cardiovascular measures such as central venous catheter advancing up to the right ventricle also induced serious hiccups 55. A patient with esophago-gastric junction tumor developed intractable hiccup after placing esophageal stent, which was likely related to irritation of afferents of hiccup reflux arc 56.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

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Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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“…Hiccups’ reflex mechanism is based on an afferent pathway (phrenic, vagus nerve and other visceral sympathetic fibers), a central processor located at the periaqueductal gray area and the subthalamic nucleus and an efferent limb travelling from the brain within the phrenic nerve to the diaphragm and accessory nerves to intercostal muscles [1, 2, 4]. The stimulation of these structures leads to a quick contraction of the diaphragm and the intercostal muscles, followed by laryngeal closure [1].…”

Section: Discussionmentioning

confidence: 99%

“…The stimulation of these structures leads to a quick contraction of the diaphragm and the intercostal muscles, followed by laryngeal closure [1]. Therefore, chemical and physical agents, or inflammatory and neoplastic status can stimulate any of these structures and cause hiccups [1, 2, 4].…”

Section: Discussionmentioning

confidence: 99%

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Septic thrombosis of internal jugular vein: a rare cause of uncontrollable hiccups

Sánchez-Gollarte

Mugüerza-Huguet

Díez‐Alonso

et al. 2019

Journal of Surgical Case Reports

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Septic thrombosis of the internal jugular vein is a possible complication related to central venous catheters. The enlargement of the diameter of the jugular vein can stimulate phrenic nerve causing hiccups and, septic thrombus can metastasize to different organs threating patient’s life. Diagnosis of septic thrombosis of internal jugular vein should be confirmed with a cervicothoracic CT-scan. Its management consists of catheter’s removal, antibiotic treatment and anticoagulation in high-risk patients. Surgical intervention might be considered if conservative treatment fails.

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“…Aber auch Läsionen an Perikard, Larynx und Ohr sind zumindest beschrieben als Auslöser für Schluckauf, möglicherweise ebenfalls über vagale Afferenzen [13]. Auch ein Singultus beim Legen eines Katheters in die Vena jugularis interna ist beschrieben (behoben durch Repositionierung), möglicherweise ebenfalls durch eine vagale Reizung verursacht [20]. Dass neben Ösophagus, Magen und Mediastinum auch Diaphragma/Pleura [21] und Peritoneum [22], [23] bei Reizung zu Schluckauf führen können, erhärtet die Annahme, dass der N. phrenicus mit seinen Afferenzen in der Schluckaufentstehung beteiligt ist.…”

Section: Die Dem Möglichen Physiologischen Reflex Am Nächsten Kommendunclassified

Singultus – Diagnostik und Therapie

Ohlrich¹,

Royl²

2017

Laryngo-Rhino-Otol

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A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the first manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other inflammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal reflux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists.

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Hiccups, a rare complication arising from use of a central venous catheter

Cited by 10 publications

References 4 publications

Hiccup: Mystery, Nature and Treatment

Hiccup: Mystery, Nature and Treatment

Septic thrombosis of internal jugular vein: a rare cause of uncontrollable hiccups

Singultus – Diagnostik und Therapie

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