Kußmaul breathing describes a type of breathing that can indicate a disease. This condition is acidosis, the over-acidification of the body due to a disturbance in the acid-base balance.
What is kissing mouth breathing?
Kußmaul respiration was named after biologist and physician Adolf Kußmaul. It is also called acidosis breathing as well as acidosis compensation breathing. It is a type of breathing called hyperventilation. It results in very deep and rapid breathing to increase the uptake of oxygen. This breathing occurs due to metabolic acidosis. This results in an over-acidification of the blood in the body of the affected person. The pH of the blood drops to below 7.35 due to an accumulation of protons. The pH value is a measurement of the acidity caused by acids and bases in the body. Acids have a pH below 7 in aqueous solution, and bases have a pH above 7. The physiological pH of humans is between 7.35 and 7.45.
Causes
The causes of Kussmaul respiration is mainly metabolic acidosis. There are many reasons for the occurrence of acidosis. Acidosis may occur due to diabetes mellitus, which has not been properly controlled by medication, or due to lactic acidosis, the accumulation of lactic acid in the body. Other causes include alcoholic ketoacidosis or prolonged starvation. Other causes of acidosis include methanol or salicyl poisoning. Acidosis can also be caused by diarrhea, a condition that results in a noticeable amount of bowel evacuation. In addition, renal insufficiency, the failure of the kidneys that leads to an accumulation of so-called urinary substances in the blood, or Addison’s disease are causes of acidosis. Addison’s disease is a life-threatening condition that leads to loss of adrenal gland function.
Symptoms, complaints, and signs
Symptoms of Kußmaul respiration include altered breathing similar to hyperventilation and metabolic acidosis. This acidosis can be detected by the characteristic odor of the affected person’s breath. Through Kußmaul breathing, the body attempts to remove carbon dioxide, which can be a source of acidosis, from the body through vigorous exhalation, normalizing the pH in the blood and thus reducing acidosis. In addition to respiration, enlargement of the liver and high blood glucose, which also suggests diabetes mellitus, are also indications of a congenital metabolic disorder. This is a congenital disorder that is divided into different categories depending on the type of metabolism that is affected. Carbohydrate metabolism, amino acid metabolism, steroid metabolism and lysosomal storage metabolism are distinguished. Lysosomes are small membrane formations that contain enzymes that serve to break down parts of the cell that are no longer needed or functional into their component parts so that they can be reused.
Diagnosis and disease progression
Kussmaul respiration is based on metabolic acidosis. This is determined with the help of a blood gas analysis. This analysis determines the pH and the concentration of oxygen and carbon dioxide in the blood. The pH value of an adult should be between 7.35 and 7.45. The partial pressure of carbon dioxide is usually between 35 and 45 mm. So-called compensated hyperacidity can also occur. Then the pH is in the normal range, but the other values of the analysis indicate a disorder. In addition, the pH value of the urine can also be determined in order to test the affected person for a possible acidosis. In the course of acidosis, oxygen deficiency occurs. The organs are not supplied with sufficient oxygen. To compensate for the increased acidity, the body releases more water. The increased acidity of the body can lead to tachycardia (rapid heartbeat). Other sequelae include a disturbance of consciousness, a decrease in blood pressure, osteoporosis, rheumatoid arthritis, arteriosclerosis and diseases of the heart. Arteriosclerosis is the hardening of the arteries, which can lead to a heart attack. Rheumatoid arthritis is a disease of the joints, which often appears with increasing age.
Complications
In most cases of Kußmaul respiration, affected individuals suffer from severe hyperventilation. Breathing difficulties occur and those affected sometimes suffer from severe fatigue and exhaustion. Likewise, it is not uncommon for the patient to experience reduced exercise tolerance. It is also not uncommon for the liver to be enlarged, leading to pain. Complaints of the liver are generally dangerous and in the worst case can lead to the death of the affected person. The patient’s metabolism is also restricted by Kußmaul’s respiration, resulting in digestive disorders and further discomfort. The patient’s quality of life is significantly reduced by this disease. Not infrequently, the complaints also lead to mental illness or depression. Furthermore, it is not uncommon for heart palpitations and disturbances of consciousness to occur. Patients may faint or fall into a coma. The treatment of Kussmaul respiration is carried out with the help of medication. Complications usually do not occur. However, treatment of the underlying disease is also necessary to prevent further sequelae.
When should you see a doctor?
Anyone who notices a strong bad breath that cannot be remedied by strict oral hygiene should visit the family doctor or dentist. If there are accompanying signs of an enlargement of the liver (such as liver pain or jaundice), a medical doctor must be consulted immediately. Severe fatigue, breathing difficulties and a reduced ability to work under pressure are further warning signs that require immediate clarification. In the event of cardiovascular problems or hyperventilation, the emergency physician must be called or the sufferer must go to a clinic. Patients suffering from diabetes, alcoholic ketoacidosis, chronic diarrhea, or renal insufficiency are particularly susceptible to developing Kussmaul respiration. The symptoms also occur in the context of Addison’s disease and lactic acidosis. People who are part of these risk groups are best to go directly to the doctor’s office so that any complications can be clarified and comprehensively treated. During treatment, the patient must see the doctor regularly. Because metabolic acidosis can recur again and again, further examinations are also necessary after treatment.
Treatment and therapy
Metabolic acidosis is treated with different therapies depending on the cause. In diabetes mellitus, there is administration of insulin. In respiratory acidosis, the respiratory system is treated directly. This is done with bronchospasmolytics, a drug that causes the bronchi to dilate. The bronchial system of the lungs includes the airways that take the inhaled or exhaled air in the lungs. To treat metabolic acidosis, buffering agents are administered to restore pH to normal. Tris buffers or sodium bicarbonate solutions are such buffering substances. If acidosis occurs due to renal insufficiency, it is treated with the help of dialysis.
Outlook and prognosis
Kussmaul respiration is a specific type of respiration. This is caused by diabetes-related or metabolic acidosis of the body. The associated hyperventilation indicates a serious problem that requires immediate medical attention. Kussmaul respiration represents an attempt by the hyperacidic or comatose organism to compensate for the acidosis by extensive exhalation of carbon dioxide. If this very deep hyperventilation breathing is not correctly recognized for what it is, the affected person is at risk of coma and subsequent death. Affected individuals usually have type 1 diabetes, very rarely type 2 diabetes. A diabetic coma associated with Kussmaul respiration is an emergency situation. This requires immediate emergency medical treatment. The cause of Kussmaul respiration is often severe hypoglycemia. However, ketoacidosis may also be present, which can be recognized by an acetone odor coming from the mouth of the affected person. The emergency response to the onset of Kussmaul respiration must take into account that the affected person may have given himself too much insulin. Alternatively, he has not ingested enough food. The prognosis is good if emergency measures are taken immediately. It is poor if help is not summoned immediately. This is the case, for example, if the patient lives alone and cannot perceive his gradual condition.
Prevention
Metabolic acidosis, and thus Kußmaul respiration, can be prevented by treating the underlying conditions that lead to hyperacidity in the body fϋ. Lung dysfunction as well as diabetes mellitus and renal insufficiency mϋust be treated early to avoid acidosis. In addition, a healthy diet and moderate consumption of alcohol are advisable to prevent the occurrence of acidosis and Kussmaul respiration. An adequate amount of fluids, mainly water, also has a positive effect on health status.
Aftercare
In the case of Kußmaul respiration, aftercare proves to be relatively difficult in most cases, with no special measures of aftercare available to the affected person at all in many cases. Therefore, a doctor should be consulted at an early stage in the case of this disease so that no further complaints occur. Only early diagnosis can prevent complications, so ideally the affected person should seek treatment at the first signs of Kußmaul respiration. As a rule, self-healing cannot occur in this case. Most sufferers are dependent on taking a variety of medications. The doctor’s instructions should always be followed. It is also important to ensure that the correct dosage is taken and that the medication is taken regularly. Since diabetes must also be treated in the case of Kußmaul’s respiration, those affected should pay attention to their diet and, if necessary, also follow a diet plan from a doctor. The further course of the disease is highly dependent on the time of diagnosis, so a general prediction cannot usually be made. However, in many cases, Kußmaul respiration significantly limits the life expectancy of the affected person.
What you can do yourself
Patients diagnosed with Kußmaul respiration should consult a specialist to determine the cause. Depending on the underlying condition of metabolic acidosis, various measures can be taken to alleviate the symptoms. If diabetes mellitus is the cause, the patient must take insulin regularly. The most important measure is to ensure that the medication is well controlled and to reduce the risks of hypoglycemia. In addition, the patient’s lifestyle must be adjusted to reduce any excess weight and to reduce the overall burden on the body. In consultation with the specialist or a nutritionist, further measures can be worked out to reduce the symptoms in the long term. If Kußmaul’s breathing is due to a disease of the respiratory system, drug treatment is indicated. Breathing exercises can help to dilate the bronchial tubes and reduce the symptoms in the long term. If metabolic acidosis underlies alcoholic ketoacidosis or prolonged fasting, diet or lifestyle changes must be made. Since these complaints usually have a psychological cause, a visit to a therapist is also useful to accompany medical treatment.
