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Sometimes there is a clear cause of hiccups which can help to resolve the event. We present a case of hiccups induced by dexamethasone in a patient with advanced cancer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 42-year-old male, diagnosed with squamous cell carcinoma of the left lung with mediastinal lymph node, hilar, supraclavicular, cervical, axillary and upper abdominal and retroperitoneal lymph node chains involvement, who was admitted to the Palliative Medicine Unit for pancreatitis. The patient had received two lines of chemotherapy (carboplatin-vinorelbine and docetaxel) and had refused to continue with a third line after progression one month earlier. The pancreatitis was resolved in a few days with medical treatment, but during admission the patient mentioned neck pain related to adenopathic lumps. Treatment was started with 8<span class="elsevierStyleHsp" style=""></span>mg of dexamethasone. After a few hours the patient had frequent bouts of hiccups, for which he was prescribed 10<span class="elsevierStyleHsp" style=""></span>mg of metoclopramide before meals and 80<span class="elsevierStyleHsp" style=""></span>mg of simethicone every 8<span class="elsevierStyleHsp" style=""></span>h, with doses of 20<span class="elsevierStyleHsp" style=""></span>mg of rescue chlorpromazine every 6<span class="elsevierStyleHsp" style=""></span>h. In the first 2 days the patient received 3–4 doses of rescue chlorpromazine daily, which only relieved temporarily him of the hiccups. He did not sleep much for two nights. His wife then mentioned that, months ago, during chemotherapy treatment, the patient had similar episodes of hiccups with each cycle, for which he was occasionally treated with chlorpromazine. It was found that before his two lines of chemotherapy he had received dexamethasone orally or intravenously. Suspecting that it was this medication inducing his hiccups, dexamethasone was replaced for 16<span class="elsevierStyleHsp" style=""></span>mg of methylprednisolone every 8<span class="elsevierStyleHsp" style=""></span>h, completely eradicating the hiccups two days after suspension of dexamethasone. The patient did not have similar episodes of hiccups.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The fact that dexamethasone induces hiccups has been known for years,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and it has been described especially in patients who have been treated with that medication, given as an antiemetic during chemotherapy. Its incidence rate is unknown, especially considering it is likely to be underdiagnosed, and that even the patient does not mention it, considering it a minor problem if it is temporary. However, it can be quite common: a prospective study<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> showed an incidence rate greater than 40%. Interestingly, all studies show a clear predominance in males, being rare in women.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is more common in patients receiving high doses (more than 10<span class="elsevierStyleHsp" style=""></span>mg daily) and rare in those receiving less than 5<span class="elsevierStyleHsp" style=""></span>mg per day. Although corticosteroids are generally described as a cause of hiccups,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> probably by stimulation of the reflex arc through steroid receptors in midbrain,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> it seems that dexamethasone is much more frequently associated with hiccups than the others are. One possible explanation would be the large range of dexamethasone through the blood–brain barrier.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In any case, treatment is based on the suspension of dexamethasone, which serves for both the diagnosis and treatment. Kang et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> described a series of 6 cases where, as was done in our patient, dexamethasone was substituted for another corticoid, resulting in the termination of hiccups in all cases, between one and two days after removal of dexamethasone. We believe, therefore, that in patients receiving dexamethasone who have persistent hiccups, the first step should be the replacement of this corticoid by another. It must especially be remembered for those patients who are given dexamethasone before chemotherapy sessions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Arriba Méndez JJ. Hipo inducido por dexametasona. Med Clin (Barc). 2016;146:284.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiccups with high dose dexamethasone administration: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Cersosimo" 1 => "M.T. 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Journal Information
Vol. 146. Issue 6.
Pages 284 (March 2016)
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Vol. 146. Issue 6.
Pages 284 (March 2016)
Letter to the Editor
Dexamethasone-induced hiccup
Hipo inducido por dexametasona
José Javier de Arriba Méndez
Unidad de Medicina Paliativa, Hospital Universitario Nuestra Señora del Perpetuo Socorro, Albacete, Spain
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