Respiratory disorders are any significant deviations in the characteristics of the respiratory movements (rhythm, depth, frequency) from the accepted norms.
Kussmaul breathing is a special pathological condition that is accompanied by difficulty and deep breathing, which is often based on severe metabolic acidosis caused by kidney failure or diabetic ketoacidosis.
Normal breathing
In a normal state, a healthy person’s breathing is rhythmic (that is, the intervals between inspirations are equal), while the inhalation is usually a little longer than the expiration, and the number of respiratory movements (i.e. the frequency) is 12-18 per minute .
During physical activity, the respiratory rate increases and can reach 25 per minute, and it can also become more superficial while maintaining a normal rhythm.
A variety of violations can indicate the localization of damage, help to make a forecast and determine the severity of the disease.
Pathological types of breathing
Kussmaul's breath will be described in more detail below.
Respiratory disorders are manifested by a change in its frequency, rhythm and depth. In accordance with this, the following types are distinguished:
- Bradypnea - respiratory depression. It is characterized by rare (less than 12 per minute) respiratory movements. It occurs due to increased blood pressure, hypoxia, stenosis of the bronchi and trachea, mountain sickness, narcotic effects, brain damage.
- Polypnoea (tachypnea) - rapid breathing. It is characterized by frequent (more than 24 per minute) respiratory movements arising from pneumonia, fever, mental disorders, intense pain in the abdominal / chest wall (gentle breathing).
- Hyperpnea is a frequent, deep breathing that occurs against the background of an acceleration of the main metabolism due to physical exertion, fever, thyrotoxicosis.
- Apnea is a temporary lack of breathing that develops as a result of a rapid increase in blood pressure, massive intoxication, hypoxia, exposure to drugs (barbiturates, ether, chloroform), a significant decrease in the amount of oxygen in the air.
Periodic breathing
In addition to those described above, the so-called periodic types of breathing are distinguished, which develop due to disturbances in the CNS excitation-inhibition system, they include the respiration of Biot, Chain-Stokes, Kussmaul.
- Biota breathing - deep breaths alternate with apnea (long pauses). It develops against the background of a coma.
- Cheyne-Stokes breathing - manifested by rare and superficial respiratory movements, gradually becoming more frequent and deeper. Reaching a maximum, they again trim and weaken, and after a pause, a similar cycle repeats again. It occurs with coma (uremic, diabetic), brain pathologies, strokes, intoxications, circulatory disorders.
In addition, they distinguish:
- Gasping-breathing, which accompanies the terminal stage of asphyxiation (in premature babies, as well as in brain stem pathologies). It is characterized by rare, weakening breaths, which alternate with prolonged apnea (up to 20 s) on exhalation.
- Breathing is dissociated, accompanied by asymmetry in the movements of the halves of the chest and paradoxical movements of the diaphragm. It is observed in brain tumors, circulatory disorders and severe damage to the nervous system.
General information (development mechanism)
Kussmaul breathing is a form of hyperventilation in which the body tries to lower the amount of carbon dioxide in the blood by increasing the depth or speed of breathing. Moreover, it is initially not deep and quick, but as the acidosis worsens, it gradually becomes difficult and deep. This condition is called Kussmaul breathing.
Reasons for the appearance
Kussmaul breathing occurs due to the following pathologies:
- Ketoacidosis is diabetic - a condition when the glucose in the blood is not used by the body as an energy source due to an acute lack of insulin, as a result of which the body is not able to get rid of the excess sugar accumulating in the blood. Most often, this condition is observed in type 1 diabetes mellitus.
- Metabolic acidosis is a condition that occurs with a significant increase in the amount of lactic acid in the blood, which leads to impaired renal function, manifested in their inability to maintain an adequate acid-base balance of the body due to a violation of filtration function.
- Pneumonia. This pathology can also cause Kussmaul breathing. With this pathology, the fluid fills the alveoli, which impedes the implementation of the normal respiratory mechanism.
- Renal failure. As mentioned above, impaired renal function leads to an excess of lactic acid, the excess of which is not excreted from the body and leads to an imbalance of acids and alkalis. It is worth noting that, before the patient has Kussmaul’s breathing, other symptoms accompanying renal failure come to the fore: vomiting, swelling in the legs, nausea, decreased urine output.
- Peritonitis is an inflammation of the peritoneum, the cause of which often lies in liver pathologies and inflammation of the gastrointestinal tract. Deterioration in peritonitis can provoke the occurrence of this type of pathological breathing.
Therapy
The treatment of such respiratory disorders begins with the treatment of the main pathology (uncorrected diabetes mellitus, renal failure, and so on), which automatically removes the phenomena of hyperventilation.
If metabolic acidosis is the cause of respiratory disorders, then the main focus of therapy is to restore the pH balance and then stabilize the general condition, and then eliminate the underlying pathology.
When breathing Kussmaul (Biota or other respiratory disorders), you should make sure that the patient has clean airways and that there are no obstacles in them. This is the most obvious cause of the violation. Determining when a patient enters Kussmaul’s breathing (Cheyne-Stokes and so on) is quite difficult.
If there is a likelihood that the patient will develop a violation of the pH balance, he should be hospitalized in order to carefully monitor changes in blood counts and to prevent the occurrence of pathological types of breathing, the appointment of appropriate therapy for the underlying disease.