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Introduction
Intractable hiccups interfere with eating and sleeping, and are exhausting and distressing to patients. As a result, patients with hiccups periodically present to the emergency department (ED) to request therapy. Although many treatments have been suggested, hiccups may prove difficult to treat. This report describes a patient who presented to the ED with prolonged hiccups that were resistant to conventional treatments. He responded dramatically to one dose of benztropine, a commonly used medication with few side effects. A Medline search revealed no previous articles discussing the use of benztropine for refractory hiccups.
Case report
A 55-year-old male presented to the ED with a 12-day history of hiccups that started shortly after the ingestion of rancid yogourt. After 3 days of symptoms, he consulted his family physician, who documented a normal physical examination and prescribed chlorpromazine (50 mg orally with a second dose to be repeated later). The hiccups continued after a short period of relief, and he revisited his doctor 2 days later. At this time he was given chlorpromazine, 50 mg intramuscularly (IM), and oral pantoprazole. The hiccups stopped for 24 hours, then returned. His doctor administered chlorpromazine 50 mg IM, and prescribed ongoing pantoprazole and chlorpromazine, 25 mg tid, as needed.
During this time he was also seen twice in the ED, where intravenous (IV) chlorpromazine and lorazepam were administered, but with no lasting relief. During one ED visit, various folk remedies were employed over 2fi hours, with no effect. Complete blood count (CBC), liver function tests, amylase, blood urea nitrogen, creatinine, chest x-ray and the results of an abdominal ultrasound were all within normal limits. After 12 days of hiccups, the patient returned for his third ED visit, stating that the hiccups were so intense he was unable to eat or sleep and, at times, had difficulty breathing.
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