Kussmaul breathing is a pattern marked by long, deep breaths in rapid succession. It is the body's natural response to high acid levels in the blood from metabolic acidosis, which has many causes and is a potentially serious and life-threatening condition. The body requires a narrow pH range for cells to survive and function. If the blood becomes too acidic, it triggers Kussmaul breathing. This respiratory pattern is hyperventilation, which helps rid the blood of excess acid through breathing off carbon dioxide.

This article will discuss Kussmaul breathing and its various causes and considerations in management.

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Kussmaul Breathing: Associated Symptoms

Kussmaul breathing may be associated with several other symptoms that occur when blood is too acidic, a condition known as metabolic acidosis. These symptoms are nonspecific, meaning they are common symptoms that have many potential causes, and include:

  • Fatigue
  • Weakness
  • Confusion
  • Nausea and vomiting

Other more specific symptoms may help point to an underlying cause of metabolic acidosis in the setting of Kussmaul breathing. For example, a person with diabetic ketoacidosis (DKA) may also have increased thirst, frequent urination, and abdominal pain. DKA is a medical emergency that requires prompt diagnosis and treatment. Someone with uremia (abnormally high levels of waste in the blood) from kidney failure may also feel itching and muscle cramps.

If you are experiencing labored breathing, seek medical attention immediately. Rapid respiratory rate and difficulty breathing can be a sign of a serious and life-threatening conditions, like heart attack and respiratory failure.

Causes of Kussmaul Breathing

Kussmaul breathing occurs to compensate for metabolic acidosis. Metabolic acidosis is a state of low blood pH that can happen when either too much acid is produced or when the kidneys cannot remove acid from the blood. Metabolic acidosis and Kussmaul breathing have many causes, but the most common causes include:

DKA is a potentially life-threatening complication of diabetes. In DKA, blood sugar levels are very high, but due to lack of insulin, the cells in the body cannot take up and use the sugar for energy. Instead, they break down fat for energy, which causes a buildup of acid in the blood.

Uremia is a serious complication of kidney failure in which the kidneys cannot rid the body of toxins, causing a buildup of acid.

Lactic acidosis is a buildup of lactic in the blood and has many underlying causes. Lactic acid is a byproduct of forms of energy production, and a buildup of lactic acid can happen when there is not enough blood flow to tissues (ischemia) or when oxygen levels in the blood are low (hypoxia). Organ failure, severe infection, and certain medications can lead to lactic acidosis.

What Medications and Substances Can Cause Kussmaul Breathing?

Overdose of certain medications can cause metabolic acidosis leading to Kussmaul breathing:

Ingestion or exposure to certain toxins can also lead to metabolic acidosis and Kussmaul breathing:

How to Treat Kussmaul Breathing

Treatment of Kussmaul breathing varies based on the underlying cause, and often requires hospitalization and management in a critical care unit. Temporary management may include administration of bicarbonate to help correct the blood pH.

In DKA, hydration with intravenous fluids and administration of insulin is needed. For uremia, renal replacement therapy with dialysis is often required.

Complications and Risk Factors Associated with Kussmaul Breathing

Metabolic acidosis can range from mild to severe and life-threatening. Once Kussmaul breathing has developed, metabolic acidosis is severe and requires urgent treatment.

Complications of metabolic acidosis include:

Risk factors for metabolic acidosis and Kussmaul breathing include:

  • Kidney disease
  • Heart failure
  • Liver failure
  • Diabetes

Are There Tests to Diagnose Kussmaul Breathing?

Kussmaul breathing has a characteristic pattern on physical examination, and a healthcare provider can recognize the characteristic pattern of deep, prolonged respirations. However, rapid respiration and abnormal respiratory patterns can also be caused by other conditions. For example, Cheyne-Stokes respiration are a pattern of cyclic rapid and shallow breathing or pauses, often as part of the dying process or seen in stroke or heart failure.

Certain blood and imaging tests are performed to evaluate for underlying causes:

  • Arterial blood gas to determine presence and type of acidosis
  • Blood chemistry for serum electrolytes, bicarbonate, and glucose levels to diagnose metabolic acidosis and evaluate for DKA
  • Complete blood count to evaluate for signs of infection
  • Lactic acid level
  • Urinalysis and urine ketones to evaluate for kidney disease and DKA
  • Chest imaging

Chest imaging can include evaluations such as a chest X-ray or computed tomography (CT) scan. These can show the condition of the lungs and whether other conditions that cause rapid respiration such as a lung infection (pneumonia), collapsed lung (pneumothorax), or blood clots (pulmonary embolism) are present.

When to See a Healthcare Provider

Seek medical attention immediately for respiratory distress or labored breathing. It is difficult to differentiate rapid breathing from Kussmaul respiration from other forms of respiratory distress. Respiratory distress may be caused by severe, life-threatening conditions like heart attack, blood clot in the lungs, collapsed lung, and severe infection or sepsis.

Other symptoms to look for and seek emergency medical care include;

  • Chest pain
  • Seizure
  • Loss of consciousness

Underlying conditions like diabetes and kidney failure are common causes of metabolic acidosis. Still, they also increase your risk of heart attack, so if you have these conditions and experience rapid breathing, seek medical attention immediately.


Kussmaul respiration is marked by a pattern of rapid, deep breathing, and is the result of an underlying metabolic acidosis. Common causes include diabetic ketoacidosis, kidney failure, and lactic acidosis from serious illness or organ failure. Treatment varies based on the underlying cause and typically requires hospitalization with intensive care.

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  3. Centers for Disease Control and Prevention. Diabetic ketoacidosis.

  4. National Kidney Foundation. Kidney failure.

  5. Medline Plus: Metabolic acidosis.

  6. Centers for Disease Control and Prevention. Diabetic ketoacidosis.

  7. MedlinePlus. Lactic acidosis.

  8. Somers V, Karim S, et al. Upright Cheyne-Stokes respiration in heart failureJ Am Coll Cardiol. 2020 Jun;75(23):2947–2949. doi:10.1016/j.jacc.2020.04.055

  9. Jung, B., Martinez, M., Claessens, YE. et al. Diagnosis and management of metabolic acidosis: guidelines from a French expert panelAnn. Intensive Care. 2019;9(92). doi:10.1186/s13613-019-0563-2

  10. Centers for Disease Control and Prevention. The surprising link between chronic kidney disease, diabetes, and heart disease.

By Angela Ryan Lee, MD

Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.

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