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| Hiccups - physiology |
Young man (25 years) tried to avoid hitting a buffalo while riding a two wheeler and fell on the outstretched hand. Initially he did not find any problem. He got up and went home. After one week he noticed a swelling of the arm and forearm. He went to the local doctor (general surgeon) and he suspected deep vein thrombosis and confirmed it on colour doppler scan. In the scan left internal jugular vein thrombosis, subclavian vein, axillary vein and upper brachial vein thrombosis was noted. He gave antibiotics and analgesics and referred him to the vascular surgery clinic for further management. Based on the clinical and colour doppler scan findings the patient was given Injection Heparin 1000 units per hour and APTT was monitored. There was no prolongation of the APTT after 2 days of anticoagulation. Then the dose was increased to 1250 units per hour. The dull aching pain and swelling was persisting in the arm and forearm. So, to relieve the pain and inflammation (traumatic) he was put on Deflazacort 4 mg x daily. The pain, swelling significantly reduced and APTT was prolonged to therapeutic levels.
He developed hiccups which bothered him throughout the day. We were not able to associate hiccups with any known medical condition and physical examination was normal, there were no neurological deficits in him. We suspected it could be due to partial injury to the phrenic nerve on the left side. We considered various pharmacological therapies for the hiccups such as chlorpromazine, haloperidol, valproic acid, gabapentin, and pregabalin. He was given Tab Pregabalin and reassured that hiccups are generally temporary and subside in couple of weeks.
Reference:
Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc. 2002;94:480–3. [PMC free article] [PubMed]
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