Biotin and Hiccups in Chronic Dialysis Patients
From 1972 to 1985, intractable hiccups were observed in 11 black chronic dialysis patients. Frequency as often as one hiccup per second, which interfered with food ingestion and speech, was termed malignant hiccups (MH). Complications of spontaneous or self-induced vomiting, ingestion of large quantities of water resulting in excessive interdialytic weight gains, and loss of dry weight resulted. Blood chemistries reflected malnutrition and alkaloses secondary to vomiting. Malignant hiccups was not relieved by various pharmacological and non pharmacological therapies attempted. Nine patients died secondary to MH-induced malnutrition; one patient was cured after transplantation; one patient's weight loss was arrested through intradialytic parenteral nutrition without hiccup relief. From 1986 to 1987, seven patients (six black, one white) with MH were treated twice daily with a multivitamin preparation containing 5 mg biotin (10 mg total). Five patients stopped hiccuping within 1 week. Hiccups recurred in two patients when biotin was discontinued and stopped with readministration. Biotin failed to relieve hiccups in two patients who had been affected for 2 years before biotin treatment, although the number of and frequency within each episode was reduced. Biotin deficiency has been implicated as a cause of neurological disorders in uremia. Pending a controlled study, the authors' findings suggest that biotin may relieve MH particularly when started as an early intervention.