Kussmaul Breathing

Kussmaul breathing is an abnormal breathing pattern characterized by rapid, deep breathing at a consistent pace. It’s a sign of a medical emergency — usually diabetes-related ketoacidosis (DKA), which can affect people with diabetes and people with undiagnosed Type 1 diabetes.


What is Kussmaul breathing?

Kussmaul breathing (also called Kussmaul respirations) is an abnormal breathing pattern characterized by rapid, deep breathing at a consistent pace. It’s a form of hyperventilation.

Kussmaul breathing is a sign of metabolic acidosis (when there’s too much acid in your bloodstream) and most commonly results from diabetes-related ketoacidosis (DKA), a potentially life-threatening complication of diabetes.

Kussmaul breathing is occasionally described as “air hunger,” emphasizing the strong need to breathe and gasping for air. People who experience Kussmaul breathing have no control over the way they’re breathing. It’s their body’s response to an underlying condition.

This type of breathing is a sign of a medical emergency. Go to the nearest emergency room if you or someone you know is experiencing Kussmaul breathing.

Kussmaul respirations were originally observed and described by Dr. Adolf Kussmaul in 1874.


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What is the difference between Kussmaul breathing and Cheyne-Stokes respirations?

Kussmaul breathing and Cheyne-Stokes respirations are both abnormal breathing patterns that are signs of potentially life-threatening conditions, but they’re different.

Cheyne-Stokes respirations can occur while you’re awake but usually occur during sleep. Cheyne-Stokes breathing involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all (apneas). The most common causes of Cheyne-Stokes respirations are heart failure and stroke.

Kussmaul breathing is rapid, deep breathing. It’s caused by metabolic acidosis, most commonly diabetes-related ketoacidosis (DKA).

What is the difference between Kussmaul breathing and hyperventilation?

Kussmaul breathing is a form of hyperventilation. Hyperventilation is technically rapid or deep breathing. It’s most often associated with anxiety or panic disorder, though it can have other causes.

Hyperventilation and Kussmaul breathing both result in lower carbon dioxide levels in your body, but with Kussmaul breathing, your body is purposefully trying to get rid of excess acid in your body in the form of carbon dioxide.

Hyperventilation alone typically isn’t dangerous, but Kussmaul breathing is a sign of a medical emergency.


Possible Causes

What are the causes of Kussmaul breathing?

Kussmaul breathing starts when acid levels in your body become too high, which is known as metabolic acidosis. Your body normally carefully controls the acidity level (pH) of your blood, which is usually in the range of 7.35 to 7.45. It’s considered acidic when it drops below 7.

When this drop happens, your body works to get rid of the extra acid by rapidly breathing out carbon dioxide, one of the main acids in your blood.

Kussmaul respirations can happen with any disorder that causes significant acidosis. The most common specific causes of Kussmaul breathing include:

  • Diabetes-related acidosis (DKA): This is the most common cause of Kussmaul breathing. Diabetes-related ketoacidosis (DKA) is a life-threatening, but treatable, complication that affects people with diabetes and those who have undiagnosed Type 1 diabetes. DKA occurs when your body doesn’t have enough insulin (an essential hormone), which your body needs to turn glucose into energy. If there’s no insulin or not enough insulin, your body starts breaking down fat for energy instead. As fat is broken down, ketones are released into your bloodstream. For a person with diabetes, a high amount of ketones causes their blood to become acidic. Kussmaul breathing tends to happen in the late stages of DKA, which is fatal if it’s not treated.
  • Renal (kidney) tubular acidosis: This condition happens when your kidneys are unable to get rid of acid through your pee properly, which causes a buildup of acid in your blood. Renal tubular acidosis may be due to several reasons, including inherited genetic conditions and autoimmune diseases. It can also happen due to primary adrenal insufficiency (Addison’s disease).

Other causes of Kussmaul breathing include:

Care and Treatment

How is Kussmaul breathing treated?

Treatment for Kussmaul breathing depends on the underlying cause. Regardless of the cause, you’ll likely need to stay in a hospital for treatment.

Healthcare providers usually treat metabolic acidosis with IV fluids and electrolytes to restore your blood’s pH balance.

In cases of diabetes-related ketoacidosis (DKA), the treatment also involves IV insulin. For renal tubular acidosis, your provider may prescribe diuretics to remove salt and water from your body.


How can Kussmaul breathing be prevented?

Kussmaul breathing — and the conditions that cause it — can’t always be prevented.

For people who have been diagnosed with diabetes, diabetes-related ketoacidosis (DKA) — especially late-stage DKA — is usually (but not always) preventable.

If you have diabetes, it’s important to check your blood sugar levels regularly and take your insulin and any other medications as prescribed to prevent or treat high blood sugar (hyperglycemia). Talk to your endocrinologist about how to manage diabetes when you get sick. Being sick can put more stress on your body and put you at a higher risk of developing DKA.

For people who have undiagnosed Type 1 diabetes, DKA can be more difficult to prevent since they may not be aware of the warning signs of Type 1 diabetes and DKA. Kussmaul breathing typically happens in late-stage (severe) DKA.

Early symptoms of DKA can include:

  • Peeing more often than usual (frequent urination).
  • Extreme thirst.
  • Dehydration.
  • Headache.
  • High amounts of ketones in your pee or blood (as shown by at-home urine ketone test strips or a blood meter test).
  • High blood sugar levels (over 250 mg/dL).

More severe symptoms of DKA can include:

  • Nausea and vomiting.
  • Abdominal pain.
  • Fruity-smelling breath.
  • Feeling very tired or weak.
  • Kussmaul breathing.

If you or your child is experiencing these symptoms, go to the nearest emergency room as soon as possible.

Care at Cleveland Clinic

When to Call the Doctor

When should Kussmaul breathing be treated by a healthcare provider?

Kussmaul breathing is usually a sign of a medical emergency. If you or someone you know is experiencing Kussmaul breathing, go to the nearest emergency room immediately.

A note from Cleveland Clinic

Kussmaul breathing is a serious sign of an underlying medical condition — most often diabetes-related ketoacidosis. If you or someone you know is experiencing rapid, deep breathing at a consistent pace, get to the nearest emergency room as soon as possible. Healthcare providers will treat it promptly and determine the underlying cause.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 01/06/2023.

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