Kussmaul Breathing: Sign of a Medical Emergency

Deep, Rapid Breathing

Medically reviewed by Josephine Hessert, DO

Kussmaul breathing is a pattern of long, deep breaths in rapid succession. It is the body's natural response to high acid levels in the blood from metabolic acidosis. Metabolic acidosis is a serious and potentially life-threatening condition. One cause of metabolic acidosis is diabetic ketoacidosis.

For cells to survive and function properly, the body requires a narrow pH range (a measurement of how acidic a substance is). If the blood becomes too acidic, it triggers Kussmaul breathing. This respiratory pattern is a type of hyperventilation. It helps rid the blood of excess acid by breathing off carbon dioxide.

This article will discuss Kussmaul breathing and its various causes and considerations in management.

Signs of a Medical Emergency

Deep, rapid breathing is a sign of a medical emergency. Call 911 or arrange transport to the nearest emergency room if you note this breathing in yourself or someone else.

Rapid respiratory rate and difficulty breathing can be a sign of serious and life-threatening conditions, like heart attack, respiratory failure, and metabolic acidosis.

What Does Kussmaul Breathing Sound Like?

Kussmaul breathing is deep, fast breathing. It is often described as "air hunger." It is not controllable by the person experiencing it. The rate and depth of the breathing is consistent, without slowing, becoming more shallow, or having episodes of breathing stoppage (apnea).

Kussmaul vs. Cheyne-Stokes Respiration

Cheyne-Stokes respiration is a cyclic pattern of rapid and shallow breathing or pauses. It's a common part of the dying process or seen in stroke or heart failure patients. In Cheyne-Stokes respiration, there is a period of long, labored breathing followed by a period of shallow, rapid breathing and moments of no breathing at all (apnea).

Kussmaul breathing is typically even and rapid, with no periods of slower breathing or stoppage of breathing. It is caused by high blood acidity and is not usually related to a heart condition.

Kussmaul Breathing: Associated Symptoms

Kussmaul breathing may be associated with several other symptoms that occur when blood is too acidic, a condition known as metabolic acidosis. These symptoms are nonspecific, meaning they are common symptoms that have many potential causes, and include:

• Fatigue

• Weakness

• Confusion

• Nausea and vomiting

Other, more specific symptoms may help point to an underlying cause of metabolic acidosis in the presence of Kussmaul breathing.

For example, in addition to Kussmaul breathing, a person with diabetic ketoacidosis (DKA) may have increased thirst, frequent urination, and abdominal pain. With ketoacidosis, the person's breath may smell fruity. DKA is a medical emergency that requires prompt diagnosis and treatment.

Someone with uremia (abnormally high levels of waste in the blood) from kidney failure may also feel itchy and have muscle cramps.

Causes of Kussmaul Breathing

Kussmaul breathing occurs to compensate for metabolic acidosis. Metabolic acidosis is a state of low blood pH that can happen when either too much acid is produced or when the kidneys cannot remove acid from the blood.

Metabolic acidosis and Kussmaul breathing have many causes, but the most common causes are:

• Diabetic ketoacidosis

• Uremia

• Lactic acidosis

DKA is a potentially life-threatening complication of diabetes. In DKA, blood sugar levels are very high, but due to a lack of insulin, the cells in the body cannot take up and use the sugar for energy. Instead, they break down fat for energy, which causes a buildup of acid in the blood.

Uremia is a serious complication of kidney failure, when the kidneys cannot rid the body of toxins, which causes an accumulation of acid.

Lactic acidosis is a buildup of lactic acid in the blood and has many underlying causes. Lactic acid is a byproduct of forms of energy production.

A buildup of lactic acid can happen when there is not enough blood flow to tissues (ischemia) or when oxygen levels in the blood are low (hypoxia). Organ failure, severe infection, and certain medications can lead to lactic acidosis.

What Medications and Substances Can Cause Kussmaul Breathing?

Overdose of certain medications can cause metabolic acidosis, leading to Kussmaul breathing:

• Aspirin overdose

• Metformin, a drug that helps control the amount of sugar in the blood

• Nucleoside/nucleotide reverse transcriptase inhibitors, a class of antiretroviral treatment for human immunodeficiency virus (HIV) that includes medications like lamivudine, emtricitabine, and abacavir sulfate

Ingestion or exposure to certain toxins, such as the following, can also lead to metabolic acidosis and Kussmaul breathing:

• Methanol

• Ethylene glycol and propylene glycol

• Cyanide

• Carbon monoxide poisoning

How to Treat Kussmaul Breathing

Treatment of Kussmaul breathing varies based on the underlying cause, and often requires hospitalization and management in a critical care unit. Temporary management may include administration of bicarbonate to help correct the blood pH.

In DKA, hydration with intravenous (IV) fluids and the administration of insulin are needed. For uremia, renal replacement therapy with dialysis is often required.

Complications and Risk Factors Associated With Kussmaul Breathing

Metabolic acidosis can range from mild to severe to life-threatening. Once Kussmaul breathing has developed, metabolic acidosis is severe and requires urgent treatment.

Complications of metabolic acidosis include:

• Coma

• Shock

• Death

Risk factors for metabolic acidosis and Kussmaul breathing include:

• Kidney disease

• Heart failure

• Liver failure

• Diabetes
  

Are There Tests to Diagnose Kussmaul Breathing?

Kussmaul breathing has a characteristic pattern upon physical examination, and a healthcare provider can recognize this pattern of deep, prolonged respirations. However, rapid respiration and abnormal respiratory patterns can also be caused by other conditions.

Certain blood and imaging tests are performed to evaluate for underlying causes, such as:

• Arterial blood gas to determine presence and type of acidosis

• Blood chemistry for serum electrolytes, bicarbonate, and glucose levels to diagnose metabolic acidosis and evaluate for DKA

• Complete blood count to evaluate for signs of infection

• Lactic acid level

• Urinalysis and urine ketones to evaluate for kidney disease and DKA

• Chest imaging

Chest imaging can include evaluations such as a chest X-ray or computed tomography (CT) scan. Images from these scans can show the condition of the lungs and the presence of other conditions that cause rapid respiration, including a lung infection (pneumonia), collapsed lung (pneumothorax), or blood clots (pulmonary embolism).

When to See a Healthcare Provider

Seek medical attention immediately for respiratory distress or labored breathing. It is difficult to differentiate the rapid breathing in Kussmaul respiration from other forms of respiratory distress. Respiratory distress may be caused by severe, life-threatening conditions like heart attack, blood clot in the lungs, collapsed lung, and severe infection or sepsis (a complication of an infection).

Other symptoms to look for and seek emergency medical care include;

• Chest pain

• Seizure

• Loss of consciousness

Underlying conditions like diabetes and kidney failure are common causes of metabolic acidosis, and they also increase your risk of heart attack. If you have these conditions and experience rapid breathing, seek medical attention immediately.

Summary

Kussmaul respiration is marked by a pattern of rapid, deep breathing, and is the result of an underlying metabolic acidosis.

Common causes are diabetic ketoacidosis, kidney failure, and lactic acidosis from serious illness or organ failure. Treatment varies based on the underlying cause and typically requires hospitalization with intensive care.

Read the original article on Verywell Health.