Kussmaul breathing

Kussmaul breathing is the very deep and labored breathing with normal or reduced frequency, [Kussmaul breathing has reduced or normal frequency, "not" increased. For instance Merriam-Webster defines Kussmaul breathing as "abnormally slow deep respiration characteristic of air hunger and occurring especially in acidotic states" [http://medical.merriam-webster.com/medical/kussmaul] . See also [http://www.whonamedit.com/syndlist.cfm/38] , [http://pharmsup.com/info/Kussmaul%20breathing.html] , [http://www.patient.co.uk/showdoc/40025292/] , [http://www.answerbag.com/q_view/490792] , [http://www.inchem.org/documents/pims/chemical/pim335.htm] , etc. Note that this occurs only in advanced stages of acidosis, and is fairly rarely reached. In less severe cased of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is a kind of very deep, gasping, desperate breathing. In some less stringent American literature any breathing pattern in acidosis is referred to as Kussmaul breathing; this is however inaccurate.] found among people with severe acidosis; it is a form of hyperventilation. [Hyperventilation means breathing that is faster and/or deeper than normal. Kussmaul breathing is deep but not fast (i.e no tachypnea).] Kussmaul breathing is named for Adolph Kussmaul, the 19th century German doctor who first noted it among patients with advanced diabetes (usually type I). He published his finding in a classic 1874 paper. [A. Kussmaul: "Zur Lehre vom Diabetes mellitus. Über eine eigenthümliche Todesart bei Diabetischen, über Acetonämie, Glycerin-Behandlung des Diabetes und Einspritzungen von Diastase in’s Blut bei dieser Krankheit.", "Deutsches Archiv für klinische Medicin, Leipzig", 1874, 14: 1-46. English translation in Ralph Hermon Major (1884-1970), Classic Descriptions of Disease. Springfield, C. C. Thomas, 1932. 2nd edition, 1939, 3rd edition, 1945.]

The cause of Kussmaul breathing is respiratory compensation for a metabolic acidosis, most commonly occurring in diabetics in diabetic ketoacidosis. Blood gases on a patient with Kussmaul breathing will show a low pCO₂ in conjunction with low bicarbonate because of a forced increased respiration (blowing off the carbon dioxide). The patient feels an urge to breathe deeply, an "air hunger", and it appears almost involuntary.

A metabolic acidosis soon produces hyperventilation, but at first it will tend to be rapid and relatively shallow. Kussmaul breathing develops as the acidosis grows more severe. Indeed, Kussmaul originally identified this type of breathing as a sign of coma and imminent death in diabetic patients.

Duration of fasting, presence or absence of hepatomegaly and Kussmaul breathing provide clues to the differential diagnosis of hypoglycemia in the inborn errors of metabolism. [Current Diagnosis and Treatment in Pediatrics, 18th Edition, Page:989]

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