Kussmaul’s breathing is a sign of a serious condition of the patient. Most patients with this symptom are in a coma. This type of respiratory movement indicates acidosis - a serious violation of the acid-base balance.
Historical data
This type of breathing is named after the German physician Adolf Kussmaul. He described such a symptom in an 1874 study. Kussmaul believed that noisy and rare breathing occurs with hyperglycemic coma in diabetics and indicates an approaching death.
It should clarify the meaning of the concept of “Kussmaul’s breath”. Not every type of lung ventilation disturbance in acidosis can be called this term. For example, a violation of the acid-base balance and respiratory function is possible with respiratory diseases, but this is a completely different symptom.
Pathological Respiratory Characteristics
Kussmaul’s breathing is very rare, deep and noisy. There is a full deep breath and labored exhalation. A man breathes, hissing. In milder cases, breathing is shallow and frequent.
As a rule, the patient is in a coma. Kussmaul’s breathing suggests that the patient’s life is in great danger, therefore emergency assistance is needed.
The mechanism of occurrence of pathological respiration
With acidosis, the acid-base balance shifts towards an increase in acidity. An excess amount of carbon dioxide is formed in the body. To compensate for this condition, the patient first begins to breathe often and superficially in order to remove carbon dioxide from the body. In this case, hyperventilation of the lungs occurs, and the respiratory center is irritated by acetoacetic and beta-hydroxybutyric acids. As the metabolic disturbances worsen, the patient begins to breathe rarely and deeply. So the breath of Kussmaul arises. This happens involuntarily, because the patient is usually in an unconscious state.
If the pathological respiration of Kussmaul is observed with a traumatic brain injury, then it is associated with damage to part of the brain stem (tire). In this case, doctors talk about neurogenic hyperventilation of the lungs. With head injuries, Kussmaul's noisy breathing continues even when the level of carbon dioxide in the blood returns to normal. In such situations, oxygen therapy does not help, because the regulation of respiratory function by the brain stem is impaired.
What conditions does abnormal breathing occur in?
If the patient has Kussmaul breathing, this is always a sign of a terminal condition and indicates a threat to life. Such a symptom occurs with the following pathologies:
- hyperglycemic (ketoacidosis) coma;
- traumatic brain injury;
- uremic coma;
- inflammation of the peritoneum;
- hepatic coma;
- stroke;
- methyl alcohol poisoning
Most often, Kussmaul respiration is observed with hyperglycemic coma. This condition occurs in diabetics with a sharp increase in glucose levels and lack of insulin. Alkalinity of blood decreases and acidosis phenomena increase. This can happen if the patient did not inject himself insulin on time. In addition to respiratory disorders, you can notice the smell of acetone from the mouth, the formation of folds and scratches on the skin, a drop in blood pressure. Before losing consciousness, a person feels thirst, nausea, weakness, drowsiness, lack of appetite.
With hypoglycemic coma, Kussmaul respiration is not observed. Low blood glucose does not lead to deviations in the acid-base balance and respiratory function is not impaired.
What are the symptoms of abnormal breathing?
The patient develops signs of pericarditis. Cervical veins swell when inhaling. This indicates a failure of the right ventricle of the heart. This manifestation in medicine is called a symptom of Kussmaul.
Due to deviations in the respiratory function, gastric motility is impaired. The abdominal wall bulges in the epigastric region and the left hypochondrium. This symptom is called a symptom of Bouvre.
During inspiration, the heart rate decreases, the pulse becomes more rare.
In patients with renal failure in a uremic coma, the smell of ammonia can come from the body.
Pneumonia, colitis, and gastrointestinal bleeding may develop. When analyzing urine, protein, white blood cells and cylinders are detected.
Treatment of pathological breathing
If the patient lost consciousness and his breathing becomes rare and noisy, it is necessary to call an ambulance. Procrastination is unacceptable here, since this condition threatens the life of a person. Before the arrival of doctors you need to provide first aid:
- Lay the patient so that his breathing is not constrained.
- Prevent tongue drooping.
- If the patient has diabetes, administer insulin.
Further therapy is carried out in a hospital setting. Kussmaul's breathing is a symptom of various ailments, so the underlying disease is treated:
- If the coma is caused by diabetes, then insulin is administered and droppers are made with saline to reduce ketoacidosis.
- With uremic coma, hemodialysis is performed.
- With hepatic coma, treatment with glucose and sodium chloride infusion solutions is indicated.
- If the coma is caused by methanol poisoning, then antidotes are administered and detoxification measures are carried out. In severe cases, hemodialysis is used.
- To eliminate metabolic acidosis with traumatic brain injuries, droppers are placed with a solution of glucose and sodium bicarbonate.
- In order to normalize breathing, inhalations with oxygen (oxygen therapy) are done.
The treatment of such conditions is always carried out in intensive care conditions. The main goal of therapy is the fight against acidosis. Respiration is normalized after the symptoms of acid-base imbalance disappear.
It is necessary to pay close attention to the condition of a person suffering from chronic ailments. At the slightest sign of deterioration, you must call a doctor. The patient should never forget to take the prescribed medication. This is especially true for patients with diabetes. Forgetfulness when taking insulin can turn into a severe coma with acidosis and Kussmaul breathing.