079 - A Patient with Hiccups "Causing" Seizures - A Crazy Medical Practice Story From Physicians

Have you ever had a patient who suffered from hiccups for years? What if those hiccups led to life-threatening complications?

In this episode, Coach JPMD shares a rare and intriguing case where a patient’s persistent hiccups resulted in severe hyponatremia.  This story not only highlights the unexpected challenges physicians might face but also emphasizes the importance of staying vigilant and prepared for even the rarest of complications.

By tuning in, you'll learn about the resilience required to handle a unique medical case and discover how setbacks in the treatment of medical cases can be challenging.

Don’t miss this crazy medical story and share it with your colleagues.

Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

Transcript

Coach JPMD (00:00.59)
Welcome back to another episode where I help younger physicians decrease stress and increase income by transitioning from corporate to independent practices, even without any business experience. Welcome to another crazy medical story with your host coach JPMD. And today's crazy medical story is about hiccups. So have you ever had a hiccup that lasted more than five minutes, 10 minutes? How about a day?

How about a year? How about five years? Most of us probably have not had a hiccup for more than a day, maybe more than a couple of hours. But this story is about a patient that had hiccups for over 10, 15 years. But the interesting thing was how the patient usually presented in our emergency room at Jackson Memorial Hospital. This is probably one of my wildest hiccup stories.

ever. You know, I have a, I have a, you know, I think most of us have a way of getting rid of our hiccups. My, my way is actually to, to hold my breath for, right before the third hiccup. So if you hold your breath before the third hiccup, you will not, your hiccup will not last a long time. Well, this patient obviously didn't do this because he's had a hiccup for more than 10 years and he would present to the emergency room with hyponatremia. So hyponatremia, if you're not a physician is a condition where your sodium level is dangerously low, which can cause seizures which can cause a process in the brain called central pontine myelinolysis.

You know what, I'm gonna have to look that word up because I probably should have researched that before I did this podcast. But it's related to the pontine gland in the in the brain. And I know I'm going to get some flack for not knowing this. But yes, it's it's a process that demyelinates a particular part of the brain which can lead to brainstem damage and actually death.

Coach JPMD (02:14.702)
So the patient would usually come to the emergency room with a sodium of a 115, 112 sometimes, and would have a seizure. And we would know him and know that he was coming in with hyponatremia because he was a frequent flyer to the emergency room. And he would be admitted to the ICU.

we would have to do some protocols or start giving them a sodium IV, hypertonic sodium, which is a high concentration sodium. But in order to correct the patient's sodium, we have to do this on a very slow basis to prevent this condition from happening. So you might ask, why was the sodium so low? Well,

The only way for him to get rid of his hiccups was to drink gallons of water. He would have gallons and gallons of water. And that was one of the only ways for him to get rid of his hiccups. So after he drank gallons of water, this caused his body to decrease his sodium level. His sodium level would go below the threshold for that. That is actually conducive to consciousness.

and he would have a seizure. So that's why he had a low sodium. That's why he had a seizure. And that's why he would be currently come to the emergency room for his condition. So you would think that maybe we can give him medications to stop the seizures or stop the hiccups. Well, we've tried, we tried every single medication that.

that's known to to medicine for his hiccups and it didn't work. And so when I was in residency, we actually tried to paralyze his diaphragm. As you know, hiccups are due to the spasm of the diaphragmatic muscle. And so we tried to actually have radiology paralyze the scalene, give him a scalene block, which, which is

Coach JPMD (04:29.592)
the nerve or the area that, innervates the phrenic nerve and the phrenic nerve innervates the diaphragm. And we tried it and it actually worked for a little bit until it actually depressed his respiration and he was almost intubated because we actually paralyzes diaphragm. And so that procedure did not work.

So I ended up leaving residency. I'm not sure what happened to him, but it was a debilitating condition that he had to live with, unfortunately. And that's the crazy medical story of the day. So why am I sharing the story? Well, I'm sharing the story because, you know, when we think that we've seen it all, we sometimes in medicine have not. And that was one case that I don't think I've ever had another patient like that.

in 25 years. So, I it was, it would be an interesting story to tell, because it's so rare. Thank you for listening to the podcast and, hope you enjoyed this week's crazy medical story. Tune in next week, Monday for another crazy medical story. And don't forget to subscribe to this podcast and, or follow this podcast on your favorite podcast app, because that's how you're going to get alerts when new episodes are released. Thank you again. See you next week.