What is Kussmaul Breathing?

Kussmaul breathing is a type of abnormal respiration, characterized by being labored and very deep, that can be seen in patients with extreme metabolic acidosis. This condition is usually identified and treated before Kussmaul breathing develops. Most commonly, this condition is observed in people with diabetic ketoacidosis leading to coma. It is a serious clinical sign and an indicator of the need for immediate medical treatment if it is not already being offered.

When patients go into metabolic acidosis, their blood becomes very acidic. The body uses a number of measures to compensate, including respiratory compensation. Patients in the early stages may breathe quickly and shallowly. As the acidosis progresses, Kussmaul breathing can develop. In Kussmaul breathing, patients breathe at a normal or slightly slower rate, but their breaths are much deeper than usual. This is a form of hyperventilation, causing carbon dioxide levels in the blood to drop while oxygen rises.

The patient's breathing is also very labored. The patient may sigh and can be obviously seen fighting for breath. Kussmaul breathing is involuntary, spurred by intense air hunger as the body attempts to compensate for the acidosis. The patient may lose consciousness by the point that Kussmaul breathing develops because the body enters a state of crisis in response to the falling pH in the blood.

This type of respiration is named for the German physician who first observed it in the 1870s while studying diabetic patients. In patients who have entered metabolic acidosis, it is critical to raise the pH level of the blood to stabilize the patient and then to determine what caused the acidosis so it can be treated. If patients are experiencing difficulty breathing, it is important to make sure the airway remains clear and to monitor the patient for signs of additional complications.

The early stages of metabolic acidosis are sometimes hard to identify unless a doctor is watching for it. People may feel unwell and can breathe shallowly and quickly, but the connection with falling blood pH may not immediately be made. In a hospital environment, blood gas tests and other labwork can show a disruption in blood chemistry, allowing care providers to intervene with appropriate treatments. People who are at risk for metabolic acidosis, such as patients with poorly controlled diabetes, should remain alert to the early warning signs so they can receive prompt medical attention before life threatening complications like coma develop.