Hiccups Workup

Updated: Dec 29, 2017
  • Author: Garry Wilkes, MBBS, FACEM; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Laboratory Studies

A wide variety of conditions may contribute to hiccups. The possibilities are narrowed down by the findings from the history and physical examination. Laboratory testing is directed toward suspected abnormalities.

  • Electrolytes - Hyponatremia can be either the cause (including Addison disease) or the effect (drinking water as a cure) of hiccups; other electrolyte-related causes are hypokalemia, hypocalcemia, and hyperglycemia
  • Renal function tests - Uremia
  • Liver function tests - Hepatitis
  • Amylase and lipase levels - Pancreatitis
  • White blood cell (WBC) count

Certain infectious diseases may cause a patient to hiccup. Appropriate testing for such infections may include the following:

  • Urine
  • Sputum
  • Cerebrospinal fluid (CSF)

Radiography, CT, and MRI

Imaging modalities that may be helpful in the workup include the following:

  • Chest radiography to identify tumors, detect infection, or assess the thoracic aorta
  • Fluoroscopy of diaphragmatic movement to confirm the diagnosis if malingering is suspected or to determine if the diaphragmatic abnormality is unilateral or bilateral before invasive therapy
  • Computed tomography (CT) of the head, thorax, and abdomen to identify tumors, infection, or structural lesions
  • Magnetic resonance imaging (MRI) to detect multiple sclerosis or evaluate vascular relations to the vagus and phrenic nerves

Other Tests

Other studies that may be helpful include the following:

  • Electrocardiography (ECG) to detect myocardial infarction (MI), pericarditis, or dysrhythmias
  • Before invasive therapy, nerve conduction studies to confirm the diagnosis and to confirm the presence of unilateral or bilateral involvement
  • Endoscopy or bronchoscopy
  • Before corrective surgery, an esophageal acid perfusion test to determine if gastroesophageal reflux is a causative factor