Kussmaul Respirations: Definition, Causes and Treatment

Kussmaul respirations or Kussmaul breathing is the abnormal breathing pattern observed in patients suffering from metabolic acidosis, diabetic ketoacidosis or some other medical condition which causes hyperventilation (a breathing pattern which involves reduction of carbon dioxide in blood due to increased rate or depth of breathing). On various occasions, existence of Kussmaul respirations is used to define any kind of breathing abnormality, which is absolutely false.
Kussmaul Respirations vs Normal Breathing

Adolph Kussmaul, a 19th century German doctor was the first one to note this characteristic breathing pattern.. In his paper published in 1874, Adolph Kussmaul described the peculiar labored breathing in diabetic coma which was later named as Kussmaul breathing in his honor. Since Kussmaul Respirations are characteristics of other primary diseases affecting a patient, there are no studies on the exact number of cases witnessed.
–    An annual incidence of Diabetic Ketoacidosis stands at 4.6 – 8.0 per 1000 patients suffering from Type 1 Diabetes.
–    Those suffering from acute metabolic acidosis also have Kussmaul breathing problem.

What is?

Kussmaul respiration is the respiratory compensation for acidosis, mostly associated with diabetic ketoacidosis. The long breaths cause a loss of carbon dioxide because the amount of CO2 exhaled becomes very high as compared to normal breathing. Rapid deep breaths lower the serum carbon dioxide levels, resulting in compensation for acidosis. Blood gasses of a patient suffering with Kussmaul respiration will always show low levels of CO2 with partially dropped levels of bicarbonate as a result of the abnormal rapid breathing.

Differential Diagnosis

On various occasions, medical literature has named any abnormal breathing pattern that occurs when a patient is in an acidotic state to be Kussmaul respiration. However, Kussmaul differs from other breathing patterns and is characterized by slow and deep breaths.
Biot’s Breathing
Though very similar to Kussmaul breathing, Biot’s breathing is characterized by periods of rapid respirations which are equal in depth, followed by a regular brief periods of apnea. The primary cause of Biot’s breathing is damage to the medulla oblongata by stroke, trauma or pressure on the medulla by tentorial hearniation.

Cheyne-Stokes respiration
The Cheyne-Stokes respiration follows a unique pattern where the breathing builds up and slows down over a short period followed by regular bouts of apnea. The deep- shallow-deep pattern is followed by approximately 30 seconds of apnea and the cycle starts over again. Each cycle takes about 30 seconds to 2 minutes to complete.

Kussmaul’s Breathing
Hyperventilation characterized by constantly deep sighing respirations in a rapid manner. The true Kussmaul breathing is generally noted in the last stages of severe acidosis, most prominently diabetic ketoacidosis. Patients suffering from Kussmaul’s breathing become ‘air-hungry’ and are seen desperately gasping for more air.

Ataxia respirations
It is a type of completely irregular breathing which doesn’t follow any set pattern and consists of irregular bouts of apnea and pauses. Damage to medulla oblongata is its major cause.

What are Causes

Top 7 Causes as below:

  • Diabetic Ketoacidosis (DKA)

Ketoacidosis is a complication caused in diabetes mellitus patients when the body starts burning fats instead of glucose for energy. The fat burning process produces abnormally high levels of blood acids called as the ketones. Kussmaul breathing is classically associated with Diabetic Ketocidosis. Ketocidosis stimulates both central and peripheral chemoreceptors controlling respiration, resulting into elevated and rhythmic breathing.

  • Metabolic acidosis

Excessive production of acid or when the kidneys fail to remove enough acid from the body leads to metabolic acidosis. If left untreated, it might lead to acidemia in which the blood pH drops below 7.35. Metabolic acidosis is characterized by nausea, vomiting and deep rapid breathing (Kussmaul Respirations).

  • Renal Failure

Renal or kidney failure is described as the loss of kidney’s water and waste product purification function. There are two main forms of failure – acute kidney injury which is often not reversible and chronic kidney disease which is not reversible. Long and deep breaths are a noted in patients suffering from acute renal failure.

  • Peritonitis

The inflammation of peritoneum (a tissue that lines the inner walls of your abdomen, covering most of the abdominal organs) caused by a bacterial or fungal infection is known as peritonitis.

  • Pneumonia

Inflammation in the lungs, primarily affecting the microscopic air sacs (alveoli) lining them, caused by infection from bacteria, viruses or other microorganisms, specific drugs and diseases is called as pneumonia. The most common symptoms of pneumonia include productive cough, fever and severe chills, shortness of breath, acute and stabbing chest pain, and an increased respiratory rate. The alveolar infection causes patients to become air hungry and take long deep breaths (Kussmaul breathing).

  • Uremia

Uremia is a renal disease which accompanies renal failure as the kidney is not able to process urea as a waste product. The retention of urea in blood causes uremia. The symptoms of uremia include nausea, vomiting, shortness of breath, cold, fatigue and more.

  • Drug administration

When sodium benzoate or sodium phenylacetate are administered to a patient through the intravenous solution, there are chances that Kussmaul respiration might be caused.


Kussmaul respiration is mostly caused by patients primarily affected by diseases like diabetic ketoacidosis, uremia, renal failure, etc. Hence the only cure for Kussmaul breathing is to treat these underlying diseases.

Kussmaul respirations video