Kussmaul breathing

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Not to be confused with Kussmaul's sign.

Graph showing the Kussmaul breathing and other pathological breathing patterns.

Kussmaul breathing is a deep and labored breathing pattern often associated

with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but
also kidney 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.
In metabolic acidosis, breathing is first rapid and shallow[1] 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.

Contents

 1Terminology
 2History
 3Mechanism
 4References

Terminology[edit]
Adolph Kussmaul, who introduced the term, referred to breathing when metabolic
acidosis was sufficiently severe for the respiratory rate to be abnormal or
reduced.[2] This definition is also followed by several other sources, [3][4] including for
instance Merriam-Webster, which defines Kussmaul breathing as "abnormally
slow deep respiration characteristic of air hunger and occurring especially in
acidotic states".[5] Other sources, however, use the term Kussmaul respiration
also when acidosis is less severe, in which case breathing is rapid. [4][6]
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.

History[edit]
Kussmaul breathing is named for Adolph Kussmaul,[2] 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.[7]

Mechanism[edit]
Kussmaul breathing is respiratory compensation for a metabolic acidosis, most
commonly occurring in diabetics in diabetic ketoacidosis. Blood gases of 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 liver enlargement and Kussmaul
breathing provide clues to the differential diagnosis of high blood sugar in
the inborn errors of metabolism.[8]

References[edit]
1. ^ Metabolic Acidosis at eMedicine
2. ^ Jump up to:a b Kussmaul's respiration at Who Named It?
3. ^ "Kussmaul breathing". encyclopedia.com. Retrieved  11 March 2010.
4. ^ Jump up to:a b "Kussmaul breathing". thefreedictionary.com. Retrieved 11
March  2010.
5. ^ "Kussmaul breathing". Merriam-Webster's Medical Dictionary. Archived from  the
original on 2008-09-23. Retrieved 2008-12-06.
6. ^ "Kussmaul respiration" at Dorland's Medical Dictionary
7. ^ 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.
8. ^ Robin R Deterding; Hay, William Winn; Myron J. Levin; Judith M. Sondheimer
(2006).  Current Diagnosis and Treatment in Pediatrics (Current Pediatric Diagnosis and
Treatment).