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Intractable hiccups during stroke rehabilitation
1Division of Rehabilitation, Washington University School of Medicine, St Louis, MO, USA.
Objective:
To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management.
Design:
Case series, retrospective chart review.
Setting:
Inpatient stroke rehabilitation floor within a tertiary care teaching hospital.
Patients:
Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases.
Interventions:
None.
Main Outcome Measure:
Response to pharmacologic treatment.
Results:
All three subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Treatment with carbamazepine was successful in only one patient; in the other two subjects, their hiccups were controlled with haloperidol or baclofen. All subjects were ultimately managed with a single agent.
Conclusions:
Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation patient. Intractable hiccups can be associated with potentially fatal consequences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding management of this challenging population.