Its etiology can be organic, psychogenic, or idiopathic.


In austere settings, some of the safer non-pharmacological remedies (Table 34-1) may be the most helpful. One of the most interesting is continuous tapping, usually for a few minutes, over the C5 vertebra until the hiccups cease. Another is self-compression of the chest by either pulling one’s knees to one’s chest or leaning forward. While some of these methods have a sound physiological base, their effectiveness is uncertain, especially with protracted hiccups.



Hiccups (singultus), an involuntary diaphragmatic spasm with a sudden closure of the glottis, is considered persistent when it lasts more than 48 hours.



Non-drug Treatments for Hiccups and Their Proposed Physiological Bases

Interruption or Stimulation of Respiration

  • Gasping with sudden fright

  • Breath holding

  • Valsalva maneuver

  • Hyperventilation

  • Rebreathing into paper bag

  • Sneezing induced with snuff or pepper

Irritation of Uvula or Nasopharynx

  • Forcible tongue traction

  • Gargling

  • Drinking pineapple juice

  • Sipping ice water

  • Drinking water while covering ears tightly

  • Swallowing hard bread or crushed ice

  • Drinking water rapidly

  • Pharyngeal stimulation with nasal catheter

  • Swallowing mixture of honey and vinegar

  • Drinking water from the “wrong side” of a glass

  • Granulated sugar swallowed dry

  • Lifting the uvula with a spoon or cotton-tipped swab

Counter-Irritation of Vagus Nerve

  • Rectal massage

Disruption of the Phrenic Nerve

  • Vapocoolant sprays or ice over C5 vertebra

  • Percussion over C5 vertebra

Counter-Irritation of the Diaphragm

  • Mustard plaster to lower chest

  • Tightly pulling knees to chest or leaning forward

Relieve Gastric Distention—Especially After Overeating

  • Gastric lavage

  • Emetic-induced vomiting

  • Nasogastric aspiration

Adapted from Friedman.1


Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.

In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.

Infection in the kidneys may spread to the bloodstream—a serious condition called sepsis—though this is also uncommon.



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