Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

Abstract

Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves’ disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.

Observation of Clinical Efficacy of Anisodamine and Chlorpromazine in the Treatment of Intractable Hiccup after Stroke

“…Stroke is often accompanied by intermittent and recurrent hiccups sometimes followed by vomiting, reflux, aspiration, and other aggravating conditions which not only affect patients' sleep but also make them in a poor mood [7][8][9]. Stroke patients with dry heat, hyperactivity of liver-yang, qi stagnation and phlegm obstruction, and deficiency of liveryin and kidney-yin can cause the internal wind to multiply the lung and stomach, which results in gastric qi trapping on the phlegm and moving the diaphragm, thus causing hiccups [10][11][12][13]. According to some research, chlorpromazine is injected into the bilateral Neiguan acupoint for the treatment of intractable hiccups, which has good effects.…”

Steroid-Induced Hiccups in a Patient Managed for Pseudo Foster-Kennedy Syndrome: A Case Report of Good Outcome With the use of Gabapentin

“…Li et al [4] reported a case of intractable hiccups in a 55-year-old woman who developed diabetic ketoacidosis and thyroid storm. In their finding, the use of metoclopramide, omeprazole, hydrotalcite, domperidone, promethazine, chlorpromazine, acupuncture, continuous infusion of traditional herbal drugs, esmolol, and rhubarb enema was no effective in controlling the condition.…”

“…These cases abate easily without any clinical significance [2]. However, hiccups can be triggered by changes in metabolic and endocrine conditions of patients [4].…”

Hiccups as a Rare Presentation of Thyrotoxicosis Triaged by an Epidural Steroid Injection

“…The primary management of hiccups begins with the identification of the cause followed by appropriate treatment. Although gastric distention and alcohol consumption are common causes of hiccups, other rare disorders including metabolic syndromes should be on the differential in a patient presenting with hiccups [2,3]. Here, we present a very unique and rare presentation of thyrotoxicosis presenting with intractable hiccups after an epidural steroid injection.…”