Hiccups in palliative care

There are many causes that can contribute to hiccups if you have a terminal illness. 

It can be caused by the terminal illness you are living with, eg, liver cancer, or other medical conditions that happen at the same time. 

Common causes of hiccups in people living with a terminal illness include:

• gut problems such as stomach distension, gastric stasis, constipation, bowel obstruction or gastro-oesophageal reflux
• metabolic conditions such as uraemia, high blood calcium, low blood potassium or low blood sodium
• infections
• liver disease
• brain conditions such as stroke, brain tumour, head injury or brain infection
• irritation of the nerves that supply your diaphragm, such as the phrenic nerve and the vagus nerve, due to surgery, tumours or infections
• medicines with anticholinergic activity, such as cyclizine or tricyclic antidepressants.

Your doctor may ask you some questions to find out the possible causes of your hiccups. They may also examine you. 

Some tests may also be done, depending on what your doctor thinks is causing your hiccups. These include:

• blood tests such as full blood count, kidney function tests or liver function tests
• imaging tests such as ECG, chest x-ray or CT scan.

If you have a medical condition, or any obvious causes of your hiccups are found, treatment will focus on the condition or cause. 

You may have many health professionals such as doctors, nurses, a palliative care specialist or a cancer specialist involved in your care, as it requires treatment from a multidisciplinary team. 

Treatment of hiccups comprises non-medicine and medicine treatment.

Non-medicine treatment

These simple measures can be effective, especially if they have worked for you previously:

• Sip iced water or swallow crushed ice.
• Breathe into a paper bag or hold your breath for a short time. 
• Use a swab to rub your soft palate.
• Pull your knee up to your chest and lean forward.

Medicines

Common medicines that may be used to treat hiccups include:

• chlorpromazine
• baclofen
• dexamethasone
• gabapentin
• haloperidol
• metoclopramide
• midazolam
• nifedipine
• simeticone.

Sometimes, hiccups can be difficult to manage despite having treatment. 

Living with hiccups and other symptoms of terminal illness can be frustrating. It can also be challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need. 

If you need extra help in daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you. 

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society, NZ
How we can help(external link) Cancer Society, NZ
NZ cancer services - find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups