Kussmaul's breathing: characteristics and causes
Kussmaul’s Breath (or big breath) is a type of pathological breathing characterised by very slow breathing acts, and in particular by a deep and noisy inhalation, followed by a short inspiratory apnoea, then a short and moaning exhalation, and finally a very prolonged post-expiratory pause
This pathological breathing owes its name to Adolf Kussmaul who described it in 1800.
Pathological causes of Kussmaul’s Breath
Kussmaul’s Breath is often associated with severe metabolic acidosis, caused in particular by diabetic ketoacidosis, or renal failure.
It is a form of compensatory hyperventilation in which increased respiratory rate is intended to increase carbon dioxide elimination to compensate for the reduction in blood pH.
If we perform an arterial blood gas analysis on the blood of a patient with Kussmaul’s breath, the results will show us a low partial pressure of CO2 in combination with a low concentration of bicarbonates.
These values can be explained by increased ventilation leading to a greater exchange (and thus removal) of carbon dioxide at alveolar level.
An excess of bases is markedly negative. The patient feels the need to breathe deeply.
He perceives an ‘air hunger’ which, as a result of the activation of the breathing control centres, also induces him involuntarily to breathe more deeply.
At first, breathing tends to be rapid and relatively shallow, but soon the metabolic acidosis evolves into hyperventilation.
Therefore, the more severe the acidosis becomes, the higher the probability of developing Kussmaul’s breathing.
It is no coincidence that Adolf Kussmaul originally identified this type of breathing as a sign of coma and impending death in diabetic patients.
Precisely because it can be observed in any form of metabolic acidosis, Kussmaul’s breathing has also been observed in terminal AIDS patients.
Duration of fasting, presence or absence of hepatomegaly and Kussmaul’s breath provide important clues for the differential diagnosis of hyperglycaemia in congenital errors of metabolism.
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