LETTER
Hiccups, Compulsive Water Drinking, and Hyponatremia
Francisco C. Ramirez and
David Y. Graham
15 April 1993 | Volume 118 Issue 8 | Page 649
TO THE EDITOR:
We report the use of the 
-aminobutyric acid analog baclofen in the prevention of symptomatic hyponatremia caused by compulsive water drinking associated with intractable hiccup.
A 58-year-old man developed hiccup in 1982. In 1985, he began to drink large volumes of water with the aim of stopping his hiccup. By October 1989, he was drinking 2 to 3 gallons of water a day, at which time he was hospitalized with a serum sodium concentration of 111 mmol/L and appropriately low urinary osmolarities. Over the next 9 months, he was admitted seven times for symptomatic hyponatremia; the median time between admissions was 23 days (mean, 29 days); the lowest admission sodium concentration was 99 mmol/L. In August 1990, therapy with the -aminobutyric acid analog baclofen was begun. The dosage was titrated to the point where no compulsive water drinking was observed (20 mg orally, four times daily). The patient did well except for one episode 8 months later when he was readmitted because of recurrent hyponatremia after discontinuation of baclofen therapy. Baclofen was reinstituted and he has remained well. His water intake is much reduced, and the frequency and severity of his hiccups have decreased.
Intractable hiccup is recognized as a potentially life-threatening condition; in our case, however, the threat was not provided by the hiccup itself but by the excessive water drinking. Hyponatremia secondary to psychogenic polydipsia in patients with hiccup has been previously reported [1], but, to the best of our knowledge, this is the first case of successful prevention with therapy aimed to treat the primary cause, intractable hiccup.
Baclofen is considered an inhibitory neurotransmitter, and its use in several patients with intractable hiccup has had apparently good results [2-4]. However, the medication has not undergone a rigorous scientific study of its efficacy in preventing hyponatremia by treating the hiccup. A recent randomized, double-blind, controlled study with four additional patients with intractable hiccup revealed a significant subjective improvement of the hiccup [5].
1. Cronin RE. Psychogenic polydipsia with hyponatremia: report of eleven cases. Am J Kidney Dis. 1987; 9:410-6.
2. Burke AM, White AB, Brill N. Baclofen for intractable hiccups. N Engl J Med. 1988; 319:1354.
3. Lance JW, Bassil GT. Familial intractable hiccup relieved by baclofen. Lancet. 1989; 2:276-7.
4. Yaqoob M, Prahbu P, Ahmad R. Baclofen for intractable hiccups. Lancet. 1989; 2:562-3.
5. Ramirez FC, Graham DY. Treatment of intractable hiccup with baclofen. Results of a double-blind randomized, controlled, cross-over study. Am J Gastroenterol. 1992; 87:1789-91.
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