Kussmaul breathing is a deep, labored breathing pattern that indicates that the body or organs have become too acidic. Some people describe this type of breathing as panicked breathing or gasping for breath.

The body is constantly doing work to maintain an average temperature and neutral blood acidity. To make sure this balance happens; the kidneys and cells rely on bases or buffers, chemical compounds that bind with hydrogen ions.

Disruptions to these compounds cause Kussmaul breathing, which is typically associated with conditions that cause metabolic disturbances, such as kidney failure and diabetes.

Fast facts on Kussmaul breathing:

  • Kussmaul breathing is a type of hyperventilation that is the lung’s emergency response to acidosis.
  • Kussmaul breathing causes a labored, deeper breathing rate.
  • It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes.
  • Because Kussmaul breathing is a sign of severe metabolic acidosis, which is a life-threatening condition, hospitalization is usually necessary.
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Kussmaul breathing and acidosis may be life threatening and require immediate medical attention.

When the body produces or ingests too much acid; or the kidneys or lungs are failing, blood acid levels increase.

If the blood becomes too acidic, acidosis occurs, and the body takes action to restore the imbalance.

By using deeper, longer breaths, the lungs can expel more acidic carbon dioxide (C02) than normal.

The condition takes its name from Adolph Kussmaul, the German physician who first described the breathing pattern in 1874.

What is the Kussmaul sign?

The Kussmaul sign refers to a rise in pressure in the jugular vein when a person breathes in.

This is considered paradoxical, because normally, the pressure in the jugular vein will fall on inspiration, as more blood returns to the right side of the heart. The Kussmaul sign can indicate a problem with the heart.

As a type of hyperventilation, some people describe Kussmaul breathing as panicked breathing, where someone appears to be gasping for breath. The deep, powerful breathing associated with Kussmaul breathing often causes inhalation and exhalation to become more evident and loud.

Some compare the sound to exaggerated sighing.

Symptoms of acidosis

Before the deep and labored patterns of Kussmaul breathing kicks in, those with metabolic acidosis typically have rapid and shallow breathing patterns. As acidosis progresses and becomes severe, Kussmaul breathing takes over.

While the signs of Kussmaul breathing are obvious, the symptoms associated with metabolic acidosis, in general, are less evident. Severe acidosis can cause organ failure, coma, and eventually death.

Common signs of metabolic acidosis include:

  • feeling sick or nauseous
  • vomiting
  • headache
  • mild confusion
  • extreme exhaustion or drowsiness without logical cause, such as time of day or amount of sleep
  • loss of appetite
  • excessive thirst
  • rapid heartbeat
  • fruity, sweet-smelling breath, which is usually a sign of diabetic ketoacidosis
  • jaundice, or yellowing of the skin and eyes
  • increased urination

It anyone suspects they may have Kussmaul breathing or acidosis, they must seek immediate medical attention.

Though diabetes is a primary cause of the condition, anything that causes an acidic blood pH can result in Kussmaul breathing. Known causes include:


When the body fails to produce enough insulin, is not processing enough glucose, and becomes extremely dehydrated, it begins to enter into survival mode, relying on fats, rather than carbohydrates, for fuel.

When fats are broken down, they release ketones that accumulate and raise blood acidity. Ketoacidosis is a serious condition most often associated with uncontrolled, or newly diagnosed diabetes.

Starvation, alcoholism, and extremely poor nutrition, however, can also cause ketoacidosis. Obesity and diets high in fats and extremely low in other nutrients, especially carbohydrates, may be a risk factor for ketoacidosis.

Lactic acidosis

A range of factors can cause tissues to become oxygen starved and lactic acid to buildup in the blood.

Common causes include:

  • organ failure, particularly heart or liver failure
  • chronic overuse of alcohol
  • certain cancers
  • seizures
  • intense overuse of muscles (overexertion, usually through exercise)
  • prolonged low blood sugar levels or prolonged elevated blood sugar levels

Drug induced acidosis

Consuming or accidentally ingesting very acidic substances or toxins may overload the body’s ability to maintain a neutral pH.

Commonly cited substances include:

  • strong alcohols, such as methanol and ethanol
  • antifreeze
  • poisons
  • acetylsalicylic acid (aspirin)
  • acetazolamide (Diamox Sequels), a diuretic medication used to treat glaucoma, seizures, and altitude sickness

Loss of bases or buffers

Conditions such as infection, diarrhea, bowel disorders, and chronic malnutrition can lead to a loss or lack of the chemical compounds that bind to and help manage hydrogen ions.

  • Kidney disorders: When the kidneys are damaged or impaired they fail to extract enough hydrogen from the blood and expel it through urine.
  • Unconsciousness: When the body goes into a state of unconsciousness due to acidosis or shock, Kussmaul breathing usually continues or sets in.
  • Sepsis: This occurs when chemicals released by the immune system to fight infection cause excessive damage to healthy tissues.

Doctors will perform a few specific tests to confirm the presence of metabolic acidosis and its severity.

Common tests include:

  • arterial blood gas tests
  • general metabolism blood panel tests
  • urine tests
  • blood sugar tests
  • electrolyte tests

Metabolic acidosis is typically diagnosed when a person’s blood acid levels (pH) are lower than 7.35.

An individual whose blood sugar levels are regularly above 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L), may be experiencing diabetic ketoacidosis. However, to be diabetic ketoacidosis, the body has to be producing ketones and have a pH that is acidic.

What is agonal breathing?

Agonal or gasping breathing is the last breathing a person does before they reach the end of their life. There may be one or two gasps only, or it may last for hours.

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Treatment focusses on addressing the cause of Kussmaul breathing.

People who experience acidosis will need to be admitted to the hospital immediately. Specific treatment plans depend on the type and severity of the acidosis.

Most people, however, are initially treated with electrolyte-enhanced fluids, either intravenously or orally.

Although Kussmaul breathing appears to be a respiratory problem, helping the person to breathe or preventing them from breathing heavily will not help the situation.

It is vital to address and treat the cause of the heavy breathing before the heavy breathing can improve. Addressing the breathing issue alone can cause more harm, as it may take away the compensatory mechanism, which is the Kussmaul breathing.

People experiencing diabetic ketoacidosis may be treated with insulin.

Those with kidney conditions may be given oral sodium bicarbonate or sodium citrate to help restore normal bicarbonate levels. As the insulin and fluid levels allow the body to return to a balanced state, the body will correct the bicarbonate levels.

Those with lactic acidosis are often given a mixture of bicarbonate supplements, intravenous fluids, insulin, and oxygen to help rebalance pH levels.

People whoa are experiencing drug or substance based acidosis may require detoxification procedures before fluid and electrolyte replacement therapies.

The only real way to lessen the chances of developing Kussmaul breathing is to reduce the risk of developing metabolic acidosis.

Common tips include:

  • managing diabetes
  • staying hydrated
  • maintaining a healthy body weight
  • maintaining a healthy, balanced diet
  • avoiding excessive or chronic alcohol intake
  • stopping exercise when muscles begin to ache or become painful