Kussmaul breathing

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]

Synonyms and keywords: Kussmaul respiration

Overview

Kussmaul breathing is the very deep and labored breathing with normal or reduced frequency,[1] found among people with severe metabolic acidosis; it is a form of hyperventilation.[2]

Historical Perspective

Kussmaul breathing is named for Adolph Kussmaul, the 19th century German Physician who first noted it among patients with advanced diabetes (usually type I). He published his finding in a classic 1874 paper.[3]

Pathophysiology

The cause of Kussmaul breathing is respiratory 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 pCO2 because of a forced increased respiration (blowing off the carbon dioxide). 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 indentified 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 hypoglycemia in the inborn errors of metabolism.[4]

References

  1. Kussmaul breathing has reduced or normal frequency, not increased, see [1], [2], [3] etc. Note that this occurs only in advanced stages of acidosis, and is farely rarely reached. In less severe cased of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is a kind of very deep, gasping, desperate breathing.
  2. Hyperventilation means breathing that is faster and/or deeper than normal. Kussmaul breathing is deep but not fast (i.e no tachypnea).
  3. A. Kussmaul: Zur Lehre vom Diabetes mellitus. Über eine eigenthümliche Todesart bei Diabetischen, über Acetonämie, Glycerin-Behandlung des Diabetes und Einspritzungen von Diastase in’s Blut bei dieser Krankheit., Deutsches Archiv für klinische Medicin, Leipzig, 1874, 14: 1-46. English translation in Ralph Hermon Major (1884-1970), Classic Descriptions of Disease. Springfield, C. C. Thomas, 1932. 2nd edition, 1939, 3rd edition, 1945.
  4. Current Diagnosis and Treatment in Pediatrics, 18th Edition, Page:989

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