Case 3: Persistent Hiccups and Vomiting in an Adolescent

Abstract

A hiccup is an involuntary, reflexlike activity that starts with contraction of the diaphragm and is terminated by the abrupt closure of the glottis. Triggers for hiccups can be central or peripheral in origin, and the differential diagnosis for hiccups is broad. Multiple systemic disorders, including gastrointestinal pathology, can cause intractable hiccups. This case focuses on an atypical presentation of a bacterial infection that presented with acute persistent hiccups in an adolescent patient.

Presentation

An 18-year-old previously healthy adolescent is admitted to the pediatric inpatient unit for dehydration after 5 days of acute-onset severe hiccups with nausea and vomiting. He has progressively worsened during the past 5 days and now has nearly continuous hiccups, which wake him from sleep. He has up to 12 episodes of nonbloody, nonbilious emesis daily and can no longer eat or drink. He has no fevers, diarrhea, rash, sick contacts, upper respiratory symptoms, recent travel, or dietary changes. He denies illicit drug or alcohol use, and his family history is noncontributory.

On examination he is afebrile and ill-appearing, with nearly continuous hiccups and frequent retching of mucus. His abdomen is nondistended, with epigastric and right upper quadrant tenderness to deep palpation. Laboratory data are normal (Table).

During the first 5 days …