Kussmaul breathing
Encyclopedia
Kussmaul breathing is a deep and labored breathing
pattern often associated with severe metabolic acidosis
, particularly diabetic ketoacidosis
(DKA) but also renal failure. It is a form of hyperventilation
, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. Kussmaul breathing is characterized as labored, deep breathing.
In metabolic acidosis, breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing
Note that Kussmaul breathing occurs only in advanced stages of acidosis, and is fairly rarely reached. In less severe cases of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is a kind of very deep, gasping, desperate breathing. Occasionally, medical literature refers to any abnormal breathing pattern in acidosis as Kussmaul breathing; however, this is inaccurate.
, the 19th century German doctor
who first noted it among patients with advanced diabetes mellitus. Kussmaul's sign
is also an eponymous finding attributable to Kussmaul, and should be distinguished from Kussmaul breathing.
He published his finding in a classic 1874 paper.
compensation for a metabolic acidosis
, most commonly occurring in diabetics in diabetic ketoacidosis
. Blood gases on a patient with Kussmaul breathing will show a low partial pressure of CO2
in conjunction with low bicarbonate
because of a forced increased respiration
(blowing off the carbon dioxide
). Base excess is severely negative. The patient feels an urge to breathe deeply, an "air hunger", and it appears almost involuntary.
A metabolic acidosis soon produces hyperventilation, but at first it will tend to be rapid and relatively shallow. Kussmaul breathing develops as the acidosis grows more severe. Indeed, Kussmaul originally identified this type of breathing as a sign of coma and imminent death in diabetic patients.
Duration of fasting, presence or absence of hepatomegaly
and Kussmaul breathing provide clues to the differential diagnosis
of hyperglycemia
in the inborn errors of metabolism.
Labored breathing
Labored respiration or labored breathing is an abnormal respiration characterized by evidence of increased effort to breathe, including the use of accessory muscles of respiration, stridor, grunting, or nasal flaring.-Classification:...
pattern often associated with severe metabolic acidosis
Acidosis
Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....
, particularly diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
(DKA) but also renal failure. It is a form of hyperventilation
Hyperventilation
Hyperventilation or overbreathing is the state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide. It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, can be brought about by...
, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. Kussmaul breathing is characterized as labored, deep breathing.
In metabolic acidosis, breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing
Terminology
Kussmaul, who introduced the term, referred to breathing when metabolic acidosis was sufficiently severe for the respiratory rate to be normal or reduced. This definition is also followed by several other sources, including for instance Merriam-Webster, which defines Kussmaul breathing as "abnormally slow deep respiration characteristic of air hunger and occurring especially in acidotic states". Other sources, however, use the term Kussmaul respiration also when acidosis is less severe, in which case breathing is rapid.Note that Kussmaul breathing occurs only in advanced stages of acidosis, and is fairly rarely reached. In less severe cases of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is a kind of very deep, gasping, desperate breathing. Occasionally, medical literature refers to any abnormal breathing pattern in acidosis as Kussmaul breathing; however, this is inaccurate.
History
Kussmaul breathing is named for Adolph KussmaulAdolph Kussmaul
Adolph Kussmaul was a German physician and a leading clinician of his time. He was born as the son and grandson of physicians at Graben near Karlsruhe and studied at Heidelberg. He entered the army after graduation and spent two years as an army surgeon...
, the 19th century German doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
who first noted it among patients with advanced diabetes mellitus. Kussmaul's sign
Kussmaul's sign
Kussmaul's sign is the observation of a rise in jugular venous pressure on inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling.-Background:...
is also an eponymous finding attributable to Kussmaul, and should be distinguished from Kussmaul breathing.
He published his finding in a classic 1874 paper.
Mechanism
Kussmaul breathing is respiratoryRespiration (physiology)
'In physiology, respiration is defined as the transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the opposite direction...
compensation for a metabolic acidosis
Metabolic acidosis
In medicine, metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low due to increased production of hydrogen by the body or the...
, most commonly occurring in diabetics in diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
. Blood gases on a patient with Kussmaul breathing will show a low partial pressure of CO2
Carbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
in conjunction with low bicarbonate
Bicarbonate
In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid...
because of a forced increased respiration
Respiration (physiology)
'In physiology, respiration is defined as the transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the opposite direction...
(blowing off the carbon dioxide
Carbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
). Base excess is severely negative. The patient feels an urge to breathe deeply, an "air hunger", and it appears almost involuntary.
A metabolic acidosis soon produces hyperventilation, but at first it will tend to be rapid and relatively shallow. Kussmaul breathing develops as the acidosis grows more severe. Indeed, Kussmaul originally identified this type of breathing as a sign of coma and imminent death in diabetic patients.
Duration of fasting, presence or absence of hepatomegaly
Hepatomegaly
Hepatomegaly is the condition of having an enlarged liver. It is a nonspecific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass...
and Kussmaul breathing provide clues to the differential diagnosis
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
of hyperglycemia
Hyperglycemia
Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...
in the inborn errors of metabolism.