Definition and Characteristics In a case report from 1874 in the Dtsch Arch Klin Med., Adolph Kussmaul described the hyperventilation associated with diabetic ketoacidosis (DKA) now known as Kussmaul respirations: “There is nothing here, as in ordinary dyspneas, to indicate that the air has to overcome the slightest obstacle on its way into or out of the lungs; on the contrary, it comes in and out with the greatest ease; the thorax widens itself splendidly in all directions, without any evidence of pulling in of the lower end of the sternum or the intercostals spaces, and a complete inspiration followed each complete respiration; down to the deepest part of the lungs, one hears a pure, loud and sharp vesicular breathing (so-called puerile breathing); and that all points to the highest degree of air hunger (Lufthunger), as does the oppressive pain of which the patient complains, as well as the tremendous activity of the respiratory muscles, which are so... Continue reading >>
Use check boxes to select individual results below 61. Diabetic ketoacidosis with pneumomediastinum: a case report Full Text available with Trip Pro Diabetic ketoacidosis with pneumomediastinum: a case report An 18-year-old male with type 1 diabetes mellitus presented to the emergency department after one day of lethargy and vomiting. Physical examination revealed a dehydrated male with tachycardia and Kussmaul's respiration. There was subcutaneous emphysema in both supraclavicular regions. Chest auscultation revealed a positive Hamman's sign. Laboratory investigation was significant for metabolic acidosis with venous blood pH 7.08. Plasma breathing patterns breathing patterns - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search breathing patterns Abnormal patterns of respiration include: Cheyne-Stokes respiration Kussmaul's breathing hyperventilation due to anxiety Biot breathing apneustic breathing paradoxical respiration sleep apnoea Links: General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis 63. Glycaemic emergencies in children (Abstract) of the classical symptoms. Severe acidosis and Kussmauls breathing (deep sighing respiration) are common. True shock (circulatory failure) as opposed to dehydration, is relatively uncommon in children with DKA. The severity of the raised glucose is not a good indicator of the onset of DKA and certainly most children with a blood glucose level of <11 are unlikely to have DKA. Nevertheless children with quite severe DKA (perhaps with blood glucose levels in the 20s) may still appear quite well. It is important 64. Paediatric - glycaemic emergencies in children (Abstract) without a long history of the Continue reading >>
What is Kussmaul Breathing? Kussmaul Breathing is the term given to a condition in which the patient builds up an extremely deep and difficult breathing pattern. This is seen mostly in individuals who are diabetic and have severe forms of metabolic acidosis, particularly diabetic ketoacidosis with kidney dysfunction. Kussmaul Breathing can likewise be clarified as a type of hyperventilation which is a condition in which an individual breathes in such a deep pattern, to the point that the level of carbon dioxide reduces in the blood, which is seen for the most part in metabolic acidosis where the breathing turns out to be more quick and shallow and as the condition exacerbates the breathing gets to be distinctly shallow and profound and it looks as though the individual is virtually gasping for breath. This kind of breathing in which the individual is essentially gasping for air is what is named as Kussmaul Breathing. Kussmaul’s Respiration There are diverse medical conditions that can influence the basic/acidic balance in your body, which means your body can turn out to be more basic or acidic. At the point when a man is acidotic, that is to say they are experiencing a pathological process (known as acidosis) that prompts to acidemia, an abnormal low pH of the blood, they may experience Kussmaul’s respiration. Kussmaul’s respiration, as German doctor Adolph Kussmaul himself portrayed, is in fact profound, slow, and labored breathing, which we now know is because of serious acidemia coming from metabolic acidosis. Nonetheless, these days, it is now and again used to portray shallow and rapid breathing examples in instances of less severe acidemia too. Reasons for this breathing pattern happening All things considered, what do you take in? Oxygen, isn’t that so? W Continue reading >>
Also found in: Dictionary, Thesaurus, Legal, Encyclopedia, Wikipedia. Related to Kussmaul breathing: Biot's breathing Kussmaul breathing abnormally deep, very rapid sighing respirations characteristic of diabetic ketoacidosis. Kussmaul breathing Air hunger Clinical medicine Rapid, deep respiration 2º to stimulation of the respiratory center of the brain triggered by ↓ pH, normal during exercise, and common in Pts with severe metabolic acidosis–eg, DKA. See Metabolic acidosis, Diabetes. breathing (breth'ing) abdominodiaphragmatic breathing A controlled method of breathing in which the diaphragm is used for inspiration and the abdominal muscles for expiration. This technique improves exertional dyspnea, esp. in patients with chronic pulmonary disease. Synonym: diaphragmatic breathing apneustic breathing An abnormal breathing pattern marked by prolonged inspiration followed by an inspiratory pause. This is usually associated with brainstem injuries. assisted breathing Any technique that improves respiration. Such breathing includes the provision of supplemental oxygen, bag-valve-mask ventilation, noninvasive ventilation, mechanical ventilation, and mouth-to-mouth ventilation. asthmatic breathing Harsh breathing with prolonged wheezing heard throughout expiration. ataxic breathing An irregular, uncoordinated breathing pattern common in infants. belly breathing Abdominal respiration. Biot breathing See: Biot breathing bronchial breathing Bronchial sounds. Cheyne-Stokes breathing See: Cheyne-Stokes respiration continuous positive-pressure breathing A method of mechanically assisted pulmonary inflation. A device administers air or oxygen to the lungs under a continuous pressure that is always greater than zero. Synonym: continuous positive-pressure ventilation diaphragmat Continue reading >>
Effects Of Diabetic Ketoacidosis In The Respiratory System
Effects of diabetic ketoacidosis in the respiratory system Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States. [email protected] Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Corpus Christy, TX 78412, United States Author contributions: All authors have contributed to the conception, design and review of the manuscript; Gallo de Moraes A has been also involved in literature review and drafting of the manuscript. Corresponding author: Alice Gallo de Moraes, MD, FACP, Assistant Professor, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. [email protected] Received 2018 Aug 24; Revised 2018 Nov 8; Accepted 2018 Dec 12. Copyright The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Diabetes affects approximately 30 million persons in the United States. Diabetes ketoacidosis is one of the most serious and acute complications of diabetes. At the time of presentation and during treatment of diabetic ketoacidosis (DKA), several metabolic and electrolyte derangements can ultimately result in respiratory compromise. Most commonly, hypokalemia, hypomagnesemia and hypophosphatemia can eventually lead to Continue reading >>
Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>
Prime Pubmed | Kussmaul Breathing Journal Articles From Pubmed
Sepsis in Latent Autoimmune Diabetes in Adults with Diabetic Ketoacidosis: A Case Report. [Journal Article] Open Access Maced J Med Sci 2019; 7(20):3501-3504Rahmadi A, Decroli E, Kam A OA CONCLUSIONS: Sepsis in LADA with DKA requires fast and appropriate management. Further search is needed to diagnose LADA. FREE Publisher Full TextPMC Free Full TextPMC Free PDF Selective 2-Adrenoceptor Agonists and Relevant Hyperlactatemia: Systematic Review and Meta-Analysis. [Journal Article] J Clin Med 2019; 9(1)Liedtke AG, Lava SAG, Far PB JC Selective 2-agonists have been imputed as potential cause of l-hyperlactatemia since the 1970s. To document the prevalence of hyperlactatemia associated with selective 2-agonists and to investigate the predisposing factors, we searched for published articles until April 2019 pertaining to the interplay of administration of selective 2-agonists and circulating l-lactic acid in the Excerpta Medi Selective 2-agonists have been imputed as potential cause of l-hyperlactatemia since the 1970s. To document the prevalence of hyperlactatemia associated with selective 2-agonists and to investigate the predisposing factors, we searched for published articles until April 2019 pertaining to the interplay of administration of selective 2-agonists and circulating l-lactic acid in the Excerpta Medica, Web of Science, and the U.S. National Library of Medicine databases. Out of the 1834 initially retrieved records, 56 articles were included: 42 papers reporting individual cases, 2 observational studies, and 12 clinical trials. Forty-seven individual patients receiving a selective 2-agonist were found to have l-lactatemia 5.0 mmol/L, which decreased by 3.0 mmol/L or to 2.5 mmol/L after discontinuing (N = 24), reducing (N = 17) or without modifying the dosage of Continue reading >>
An outline of management is presented: this should be tailored to individual circumstances. Management of DKA has passed through 3 stages in the last 100 years: Stage 1: Preinsulin era (Feature: mortality of 100%) Stage 2: High dose insulin regime (Feature: mortality down to 10% but metabolic complications due to the treatment) Stage 3 (the present): Low dose insulin regime (Feature: low mortality) Mortality with the low dose insulin regime is down to about 2 to 5% overall. In older patients with DKA precipitated by a major medical illness (eg acute pancreatitis, myocardial infarction, septicaemia), the mortality rate is still high due to the severity of the precipitating problem. Restore normal carbohydrate and lipid metabolism Management can be considered in terms of emergency and routine components. Protect by intubation with a cuffed tube if patient is significantly obtunded. Consider placing a nasogastric tube in all patients. Intubation may be necessary for airway protection or ventilation (eg if aspiration, coma, pneumonia, pulmonary oedema, acute pancreatitis and ARDS) but this is not common. Maintain compensatory hyperventilation in intubated patients Patients with metabolic acidosis (eg severe DKA) have marked hyperventilation (ie respiratory compensation, Kussmaul respirations) and typically low arterial pCO2 levels. If intubated and ventilated, ventilatory parameters (tidal volume and rate) need to be set to continue a high minute ventilation. If this is not done and pCO2 is inappropriately high, a severe acidaemia and consequent severe cardiovascular collapse may occur This is a particular problem in all situations where a patient with a compensated metabolic acidosis is intubated and ventilated. The rule of thumb is to aim for a pCO2 level of 1.5 times th Continue reading >>
[ketoacidotic Diabetic Metabolic Dysregulation: Pathophysiology, Clinical Aspects, Diagnosis And Therapy].
Abstract When glucose utilisation is impaired due to decreased insulin effect, ketones are produced by the liver from free fatty acids to supply an alternate source of energy. This adaptation may be associated with severe metabolic acidosis and tends to occur in patients with type I (insulin-dependent) diabetes mellitus. In addition, hypovolemia is an almost invariable finding with marked hypoglycemia and is primarily induced by the associated glucosuria. Ketoacidosis stimulates both the central and peripheral chemoreceptors controlling respiration, resulting in alveolar hyperventilation (Kussmaul's respiration). With the ensuing fall in pCO2 the patient tries to raise the extracellular pH. A fruity odor of acetone on the patient's breath sometimes suggests that ketoacidosis is present. The classical triad of symptoms associated with hyperglycemia are polyuria, polydipsia, and weight loss. Circulatory insufficiency with hypotension is not uncommon due to the marked fluid loss and acidemia. In more severely affected patients, neurologic abnormalities may be seen, including lethargy, seizures or coma. Some patients also have marked vomiting and abdominal pain. The history and physical examination may provide important clues to the presence of uncontrolled diabetes mellitus. Once suspected, the diagnosis can be easily confirmed by measuring the plasma glucose concentration. Glucosuria and ketonuria can be semiquantitatively detected with reagent sticks. Blood gas analysis and anion gap give objective information as to the severity of the metabolic acidosis. Therapy must be directed toward each of the metabolic disturbances: hyperosmolality, ketoacidosis, hypovolemia and potassium, and phosphate depletion. The mainstays of therapy are the administration of low-dose insulin Continue reading >>
Cheyne Stokes Breathing And Other Abnormal Respiration
Cheyne Stokes breathing is a type of abnormal breathing. It’s characterized by a gradual increase in breathing, and then a decrease. This pattern is followed by a period of apnea where breathing temporarily stops. The cycle then repeats itself. Normal breathing, the process of moving air in and out of the lungs 12 to 20 times per minute, is something most people seldom think about. However, abnormal breathing like Cheyne Stokes is serious and may be frightening. When does it most likely occur? According to research, Cheyne Strokes breathing can happen while you’re awake, but is more common during sleep. It may happen more during non-rapid eye movement (NREM) sleep than rapid eye movement (REM) sleep. When Cheyne Stokes occurs during sleep, it’s considered a form of central sleep apnea with an extended period of fast breathing (hyperventilation). Central sleep apnea causes you to stop breathing briefly and increases the levels of carbon dioxide in your body. Cheyne Stokes is usually related to heart failure or stroke. It may also be caused by: brain tumors traumatic brain injuries high altitude sickness encephalitis increased intercranial pressure chronic pulmonary edema People who are dying often experience Cheyne Stokes breathing. This is a natural effect of the body’s attempt to compensate for changing carbon dioxide levels. While it may be distressing to those who witness it, there’s no evidence Cheyne Stokes is stressful for the person experiencing it. Both Kussmaul breathing and Cheyne Stokes breathing are characterized by fast breathing and too much carbon dioxide in the body, but that’s where their similarities end. Kussmaul breathing doesn’t alternate between fast and slow breathing or cause breathing to stop like Cheyne Stokes does. Instead, it’ Continue reading >>
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What Can Cause Kussmaul Breathing & How Is It Treated?
Kussmaul Breathing is the name given to a condition in which the patient develops an extremely deep and labored breathing pattern. This is seen mostly in people who are diabetic and have severe forms of metabolic acidosis, especially diabetic ketoacidosis with kidney dysfunction. Kussmaul Breathing can also be explained as a form of hyperventilation which is a condition in which an individual breathes in such a deep pattern that the level of carbon dioxide decreases in the blood, which is seen mostly in metabolic acidosis where the breathing becomes extremely fast and shallow and as the condition worsens the breathing becomes shallow and deep and it looks as if the individual is virtually gasping for breath. This type of breathing in which the individual is virtually gasping for air is what is termed as Kussmaul Breathing. Kussmaul Breathing is a condition which results due to low levels of carbon dioxide in the blood. It is normally seen in people who have uncontrolled diabetes to level where they develop diabetic ketoacidosis resulting in the patient to have a very shallow and deep breathing. The carbon dioxide level decreases due to the desire of the individual to take a deep breath and exhale more amount of carbon dioxide than the norm resulting in a marked decrease in the level of carbon dioxide in the blood causing hyperventilation or Kussmaul Breathing. The conditions which can cause Kussmaul Breathing are: Diabetic Ketoacidosis: Diabetic ketoacidosis is a condition in which the glucose present in the blood is not able to be used by the body to produce energy because of severe need for insulin which is not there. This results in the inability of the body to get rid of the glucose to produce energy for the body. Metabolic Acidosis: This is a medical condition in w Continue reading >>
What Is Kussmaul Breathing?
People with diabetes mellitus, especially type 1 diabetes and rarely in type 2 diabetes, tend to burn fatty acids which brings changes in the breathing patterns. Apart from diabetes, other forms of metabolic acidosis also result in Kussmaul breathing . The breathing is usually involuntary, in an effort by the body to get rid of unnecessary acids. Read on to find out more about Kussmaul breathing . In type 1 diabetics, when the body runs out of insulin or is not provided with enough insulin (especially during the times of excessive physical activity), it starts to burn fatty acids to produce energy. Burning fatty acids produces ketones as waste products which are released into the blood stream increasing the acidity of the blood (diabetic ketoacidosis). If the kidneys fail to discharge this excess acids through urine or if there is too many of acid units than the kidneys can process, the only way the body can reduce acidity is through respiration. In the beginning the breathing pattern is usually rapid, short, and shallow, and as the acidosis progresses it becomes slow, deep, and long to exhale the acids. This is similar to hyperventilation with characteristics of air hunger and results in a decrease in partial pressure of carbon dioxide and bicarbonate levels in the blood. The reason behind this abnormal breathing pattern is differentiated by the presence of high blood sugar levels from other forms of ketoacidosis. The presence of high blood sugar levels indicates diabetic ketoacidosis. In less severe cases of metabolic acidosis or diabetic ketoacidosis, the breathing usually comes back to normal when the blood’s composition becomes normal. Severe cases of acidosis along with this type of breathing can lead to coma. If you find yourself or someone you know suffering f Continue reading >>
Kussmaul Breathing: Pathophysiology, Causes And Treatment
Kussmaul breathing: Pathophysiology, Causes and Treatment by Dr. Cameron Troup MD in Respiratory Diseases Definition: it is a very dangerous symptom that accompanies the conditions associated with the alteration of the organs and the acidification of the organism. Kussmauls breathing is described as slightly faster breathing with extenuating deep breaths.It is a reflexive reaction of the organism and is usually present in unconscious patients. Kussmauls breathing is the name given to a condition in which the patient develops an extremely deep and laborious breathing pattern. This is mainly observed in people who are diabetic and have severe forms of metabolic acidosis, especially diabetic ketoacidosis with renal dysfunction. Kussmauls breathing can also be explained as a form of hyperventilation . That is, it is a condition in which an individual inhales in a pattern so deep that the level of carbon dioxide decreases in the blood, which is seen especially in metabolic acidosis where breathing becomes extremely rapid and shallow and as the condition worsens the breathing becomes shallow and deep. It seems as if the individual is practically panting to breathe. This type of breathing pattern was first described by Adolph Kussmaul, a German physician in 1874. He realized that his patients with diabetic ketoacidosis had a breathing pattern that was first labeled as having air hunger. In Kussmauls type of breathing, the patient breathes a lot, that is, it is a hyperventilation along with tachypnea.So were going to find that the amplitude of the breaths along with the rate will increase.There are usually no pauses between breaths. This is not specific for diabetic ketoacidosis.It can also appear in other types of severe metabolic acidosis, for example, alcoholic ketoacidosis Continue reading >>
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 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, who introduced the term, referred to breathing when metabolic acidosis was sufficiently severe for the respiratory rate to be abnormal 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 Kussmaul, the 19th century German doctor who first noted it among patients with advanced diabetes mellitus. Kussm Continue reading >>
Understanding The Presentation Of Diabetic Ketoacidosis
Hypoglycemia, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) must be considered while forming a differential diagnosis when assessing and managing a patient with an altered mental status. This is especially true if the patient has a history of diabetes mellitus (DM). However, be aware that the onset of DKA or HHNS may be the first sign of DM in a patient with no known history. Thus, it is imperative to obtain a blood glucose reading on any patient with an altered mental status, especially if the patient appears to be dehydrated, regardless of a positive or negative history of DM. In addition to the blood glucose reading, the history — particularly onset — and physical assessment findings will contribute to the formulation of a differential diagnosis and the appropriate emergency management of the patient. Pathophysiology of DKA The patient experiencing DKA presents significantly different from one who is hypoglycemic. This is due to the variation in the pathology of the condition. Like hypoglycemia, by understanding the basic pathophysiology of DKA, there is no need to memorize signs and symptoms in order to recognize and differentiate between hypoglycemia and DKA. Unlike hypoglycemia, where the insulin level is in excess and the blood glucose level is extremely low, DKA is associated with a relative or absolute insulin deficiency and a severely elevated blood glucose level, typically greater than 300 mg/dL. Due to the lack of insulin, tissue such as muscle, fat and the liver are unable to take up glucose. Even though the blood has an extremely elevated amount of circulating glucose, the cells are basically starving. Because the blood brain barrier does not require insulin for glucose to diffuse across, the brain cells are rece Continue reading >>