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Characteristics and Treatments of Coronavirus Disease 2019 Patients Presenting With Persistent Hiccups: A Scoping
Michael Boulis1, Mary Boulis1, Marianne Cosgrove
1Central Connecticut State University, New Britain.
Insights
Persistent hiccups can be an atypical symptom of coronavirus disease 2019 (COVID-19). Early diagnosis and treatment with chlorpromazine are recommended for COVID-19 patients experiencing intractable hiccups.
Area of Science:
- Infectious Diseases
- Neurology
Background:
- Persistent hiccups (>48 hours) are an uncommon presentation of COVID-19.
- COVID-19 can manifest with atypical symptoms, including prolonged hiccups, even without typical respiratory or systemic signs.
Purpose of the Study:
- To characterize COVID-19 patients with persistent hiccups.
- To review treatments for persistent hiccups in COVID-19 cases.
Main Methods:
- A scoping review was conducted using the Arksey and O'Malley methodology.
- Literature search for cases of persistent hiccups in COVID-19 patients.
Main Results:
- Fifteen male cases (29-72 years) were identified.
- Over one-third of patients lacked typical COVID-19 symptoms.
- All cases tested positive for SARS-CoV-2 with lung involvement on imaging.
- Chlorpromazine (83% success) and baclofen (100% success) were effective; metoclopramide showed 0% success.
Conclusions:
- COVID-19 should be considered in patients with persistent hiccups, even without other symptoms.
- SARS-CoV-2 testing and chest imaging are recommended for diagnosing persistent hiccups.
- Chlorpromazine demonstrates superior efficacy over metoclopramide for managing hiccups in COVID-19 patients.
Objectives:
Over the time of the pandemic, coronavirus disease 2019 (COVID-19) has surprised us with a growing list of atypical presentations, one of which is persistent hiccups that last more than 48 hours. The aim of this review is to investigate the characteristics of COVID-19 patients presenting with persistent hiccups and explore treatments used to control persistent hiccups in such cases.
Methods:
This scoping review was performed utilizing the methodological approach proposed by Arksey and O'Malley.
Results:
Fifteen relevant cases were identified. All reported cases were males, aged between 29 and 72 years. More than one-third of the cases did not have symptoms of infection. All cases had a positive severe acute respiratory syndrome coronavirus reverse transcriptase-polymerase chain reaction, as well as lung involvement evident on chest imaging. The medications most frequently used for hiccups in the reported cases were chlorpromazine (6 cases, 83% success), metoclopramide (5 cases, 0% success), and baclofen (3 cases, 100% success).
Conclusions:
In patients presenting with persistent hiccups during this pandemic, even in those lacking systemic or other manifestations of COVID-19 or pneumonia, clinicians are encouraged to consider COVID-19 as one of the differential diagnoses. In light of the findings of this review, it is recommended to include a severe acute respiratory syndrome coronavirus reverse transcriptase-polymerase chain reaction test and a chest imaging as part of the workup for these patients. When considering treatment options, this scoping review shows that chlorpromazine has more favorable outcomes compared with metoclopramide for controlling persistent hiccups in COVID-19 patients.
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