Kussmaul breathing is a deep and labored breathing pattern often associated with severe

metabolic acidosis Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys ...

, particularly

diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of ...

(DKA) but also

kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

. It is a form of

hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the bloo ...

, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. In

, 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

Adolph Kussmaul Adolph Kußmaul (german: Carl Philipp Adolf Konrad Kußmaul; 22 February 1822 – 28 May 1902) 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 He ...

, 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. Kussmaul breathing occurs only in advanced stages of acidosis, and is not commonly seen. Rapid, shallow breathing may be observed in less severe cases but Kussmaul breathing is a characteristic deep, gasping - even desperate - manner of respiratory distress. Occasionally, medical literature may refer to any abnormal breathing pattern in acidosis as Kussmaul breathing.

History

Kussmaul breathing is named for

, the 19th century German

doctor Doctor or The Doctor may refer to: Personal titles * Doctor (title), the holder of an accredited academic degree * A medical practitioner, including: ** Physician ** Surgeon ** Dentist ** Veterinary physician ** Optometrist *Other roles ** ...

who first noted it among patients with advanced

diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

. 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.

Mechanism

Kussmaul breathing is respiratory compensation for a

, most commonly occurring in

diabetic Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

s in

. Blood gases of a patient with Kussmaul breathing will show a low partial pressure of CO₂ in conjunction with low

bicarbonate In inorganic chemistry, bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. It is a polyatomic anion with the chemical formula . Bicarbonate serves a crucial biochemi ...

because of a forced increased respiration (blowing off the

carbon dioxide Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is t ...

). 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 In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

high blood sugar Hyperglycemia is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but symptoms may not start to become noticeable until even ...

in the

inborn errors of metabolism Inborn errors of metabolism form a large class of genetic diseases involving congenital disorders of enzyme activities. The majority are due to defects of single genes that code for enzymes that facilitate conversion of various substances ( substra ...

References

{{Eponymous medical signs for respiratory system Endocrinology Breathing abnormalities