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 >>
Kussmaul Breathing - An Overview | Sciencedirect Topics
Nicholas J. White, in Manson's Tropical Infectious Diseases (Twenty-third Edition) , 2014 Hyperventilation or Kussmaul's breathing (sometimes termed respiratory distress) is a poor prognostic sign in malaria. In the tachypnoea associated with high fever, breathing is shallow compared with the ominous laboured hyperventilation associated with metabolic acidosis, pulmonary oedema or bronchopneumonia. Acute pulmonary oedema (acute respiratory distress syndrome) may develop at any time in severe falciparum malaria. It is particularly common in pregnant women, but rare in children. In some cases malaria ARDS may be difficult to distinguish clinically from pneumonia. The heart sounds are normal. The central venous pressure and pulmonary artery occlusion pressures are usually normal, the cardiac index is high and systemic vascular resistance is low. This points to an increase in capillary permeability (unless the patient has been overhydrated). The chest radiograph shows increased interstitial shadowing and a normal heart size. Julian L. Seifter, in Goldman's Cecil Medicine (Twenty Fourth Edition) , 2012 Symptoms include nausea, vomiting, anorexia, polydipsia, and polyuria. Patients often exhibit Kussmaul respirations and volume depletion. Neurologic symptoms include fatigue and lethargy with depression of the sensorium. CSF exhibits a change in acid-base status with treatment of diabetic ketoacidosis. Even without bicarbonate administration, CSF pH falls as a result of the ventilatory response to the correction of acidosis and the sudden rise in Pco2. However, no correlation between decreased CSF pH and depression of sensorium has been established. Ketoacidosis is also seen in cases of starvation, in which it is generally mild and not associated with hyperglycemia. Ketoacids Continue reading >>
What Type Of Breathing Problem Is Kussmaul Breathing?
What type of breathing problem is kussmaul breathing? This pattern of fast, deep breaths sometimes happens in people who have a problem related to diabetes known as diabetic ketoacidosis. When you have diabetes, your body doesnt use sugar for energy the way it should. Instead, it burns stored fat for energy. That raises the level of acid in your blood. Your body tries to get things back into balance by getting rid of more carbon dioxide, so you breathe in faster and breathe out more deeply. It can also lead to fruity-smelling breath. The Cleveland Clinic: Vital signs, Dysnpea. Johns Hopkins Medicine: Vital signs, Hyperventilation, Transient Tachypnea of Newborn. Annals of Allergy, Asthma, & Immunology: Exercise-induced hyperventilation -- a pseudoasthma syndrome. Journal of Behavioral Medicine: Rebreathing to cope with hyperventilation: experimental tests of the paper bag method. International Journal of Psychophysiology: Hyperventilation in Panic Disorder and Asthma: Empirical Evidence and Clinical Strategies. McGee, Steven. fourth edition. Evidence-Based Physical Diagnosis, Walker, HK. third edition. Clinical Methods: The History, Physical, and Laboratory Examinations, Journal of Clinical Medicine: PlatypneaOrthodeoxia Syndrome. Journal of Clinical Investigation: Bradycardia during sleep apnea, characteristics and mechanism. Kansas Health System: Poison facts carbon monoxide. Respirology: Effect of increasing respiratory rate on airway resistance and reactance in COPD patients. EMDocs: Approach to Tachypnea in the ED Setting. Canadian Respiratory Journal : Altered respiratory physiology in obesity. Basic Research in Cardiology : Exertional hyperpnea in patients with chronic heart failure is a reversible cause of exercise intolerance. American Journal of Respiratory a 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 >>
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 >>
Hyperosmolar Hyperglycemic State
Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyperosmolar hyperglycemic state (HHS), occurring primarily in type 2 diabetes. In type 1 diabetes, no insulin is available to suppress fat breakdown, and the ketones resulting from subsequent ketogenesis manifest as DKA. This is in contrast to type 2 diabetes, in which patients can still secrete small amounts of insulin to suppress DKA, instead resulting in a hyperglycemic state predominated simply by glucose. The clinical presentation of both DKA and HHS is one of polyuria, polydipsia, nausea and vomiting, volume depletion (e.g., dry oral mucosa, decreased skin turgor), and eventually mental status changes and coma. In patients with altered mental status, fingerstick glucose should always be checked in order to exclude serum glucose abnormalities. Several clinical findings pertaining only to DKA include a fruity odor to the breath, hyperventilation, and abdominal pain. HHS patients, in contrast to those with DKA, will present with more extreme volume depletion. The treatment of both DKA and HHS is primarily IV electrolyte and fluid replacement. Insulin for hyperglycemia may be given with caution and under vigilant monitoring of serum glucose. Other treatment options depend on the severity of symptoms and include bicarbonate and potassium replacement. Osmotic diuresis and hypovolemia Hypovolemia resulting from DKA can lead to acute Continue reading >>
What Is Kussmaul Breathing?
Kussmaul breathing is a deep, labored breathing pattern that indicates that the body or organs have become too acidic. The body is constantly doing work to maintain an average temperature and neutral blood acidity. To make sure this balance happens; the kidneys and cells rely on bases or buffers, chemical compounds that bind with hydrogen ions. Disruptions to these compounds cause Kussmaul breathing, which is typically associated with conditions that cause metabolic disturbances, such as kidney failure and diabetes. Contents of this article: Kussmaul breathing is a type of hyperventilation that is the lung's emergency response to acidosis. Kussmaul breathing causes a labored, deeper breathing rate. It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes. Because Kussmaul breathing is a sign of severe metabolic acidosis, which is a life-threatening condition, hospitalization is usually necessary. What is Kussmaul breathing? When the body produces or ingests too much acid; or the kidneys or lungs are failing, blood acid levels increase. If the blood becomes too acidic, acidosis occurs, and the body takes action to restore the imbalance. By using deeper, longer breaths, the lungs can expel more acidic carbon dioxide (C02) than normal. The condition takes its name from Adolph Kussmaul, the German physician who first described the breathing pattern in 1874. Symptoms As a type of hyperventilation, some people describe Kussmaul breathing as panicked breathing, where someone appears to be gasping for breath. The deep, powerful breathing associated with Kussmaul breathing often causes inhalation and exhalation to become more evident and loud. Some compare the sound to exaggerated sighing. Symptoms of acidosis Before the deep and labore Continue reading >>
Kussmaul Breathing, Cheyne-stokes Respiration & Biot's Respiration Terms
Technical Terms for Respiration There are several weird-sounding terms related to respiration that seem harder to understand than they really are. Actually, their definitions may vary just a bit depending on setting: academic or practical. These are Kussmaul's respiration, Cheyne-Stokes respiration, and Biot's (or Bee-oh's) respiration. It all sounds kind of technical and a bit out there, but, by the end of this lesson, you'll be a pro at explaining what these are. Kussmaul's Respiration There are different medical conditions that can affect the acid/base balance in your body, meaning your body can become more acidic or basic. When a person is acidotic, that is to say they are undergoing a pathological process (known as acidosis) that leads to acidemia, an abnormally low pH of the blood, they may experience Kussmaul's respiration. Kussmaul's respiration, as German physician Adolph Kussmaul himself described, is technically deep, slow, and labored breathing, which we now know is in response to severe acidemia stemming from metabolic acidosis. However, nowadays, it is sometimes used to describe rapid and shallow breathing patterns in cases of less severe acidemia as well. Why does this type of breathing pattern occur? Well, what do you breathe in? Oxygen, right? What do you breathe out? Carbon dioxide. Carbon dioxide is acidic. It lowers the pH of the blood. By breathing rapidly and/or deeply, the body tries to blow off excess CO2 to increase pH back to normal, like an old train engine tries to blow off steam to cool itself off. Such respiration can be seen in patients with diabetic ketoacidosis or renal (that is to say, kidney) failure among other problems. Cheyne-Stokes Respiration The next form of respiration I want to get to is a bit more difficult to understand, but 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 >>
Clinical Profile Of Diabetic Ketoacidosis: A Prospective Study In A Tertiary Care Hospital
Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital 1Assistant Professor, Department of Emergency Medicine, Dayanand Medical College and Hospital, Ludhiana, India. 2Assistant Professor, Department of Emergency Medicine, Dayanand Medical College and Hospital, Ludhiana, India. 3Assistant Professor, Department of Emergency Medicine, Dayanand Medical College and Hospital, Ludhiana, India. NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Harpreet Kaur, Assistant Professor, Department of Emergency Medicine, Dayanand Medical College and Hospital, Ludhiana-141001, India. E-mail: [email protected] Received 2014 Jan 21; Revisions requested 2014 May 16; Accepted 2015 Apr 9. Copyright 2015 Journal of Clinical and Diagnostic Research This article has been cited by other articles in PMC. Diabetic ketoacidosis, a well-known and major acute metabolic complication classically occurs in young patients with type 1 diabetes. However, it may occur in patients with type 2 Diabetes Mellitus too. Aim of this study was to look into the clinical profile, precipitating factors and clinical outcome in the patients presenting with Diabetic ketoacidosis in the Emergency of a Tertiary care hospital. The study was a prospective study conducted over a period of two years in Kasturba Medical College, Manipal Karnataka, India. Clinical profile of 60 diabetic patients admitted in the Emergency with the diagnosis of Diabetic ketoacidosis were analysed. Out of 60 patients, 12 were of Type 1 and 48 were Type 2 Diabetes Mellitus. Mean duration of diabetes was 8.65 years. Only 14 (23.3%) patients were taking regular treatment for Diabetes Mellitus whereas 32 (53.33%) patients were on irregular treatment and eight (13.33%) were not on any treatment at all. Continue reading >>
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Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia: Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA. Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA. However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>
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? 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 >>
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 >>
Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State
The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>