Kissing mouth breathing

In 1874 Adolf Kußmaul (1822-1902) first described the special respiration at the Coma diabeticum, which was later named after him and is known as Kußmaul's respiration (Kluge 2003).

So-called kissing mouth breathing is a special form of breathing which is not a primary disturbance of the respiratory centre but rather an attempt to respiratoryly compensate an existing metabolic acidosis (Leps 2003). The respiration is strongly deepened, mostly normofrequent or slightly accelerated. Exhaled air smelling of acetone (fruity taste) is typical (Kasper 2015).

Kussmaulsche respiration occurs in the context of metabolic acidosis and serves as respiratory compensation as the body tries to correct the low pH-value through increased exhalation of CO2 (Leps 2003).

This can be the case according to Schoenenberger (Schoenenenberger 2009):

• through increased H+ production (e.g. in diabetic coma)
• by reduced renal H+ excretion (e.g. in uremic coma)
• due to severe bicarbonate losses (e.g. severe diarrhoea)

• Dyspnea (but can also be absent)
• increasing somnolence
• Agitation
• increasing disorientation

The diagnosis is made by:

• clinical observation
• Blood gas analysis

Immediate treatment of the disease underlying metabolic acidosis (Schoenenberger 2009).

The prognosis is determined by the underlying disease.

1. Herold G et al (2018) Internal Medicine Herold Verlag S 594
2. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education S 317, 2418
3. Kluge F J et al (2003) Think clearly, feel warm, act calmly: Adolf Kußmaul (1822-1902) and his significance for medicine in the 21st century. Z Rheumatol 62: 484-490
4. Leps W et al (2003) Internal Medicine: GK 3 original exam questions with comments. Georg Thieme publishing house S 350
5. Müller-Wieland D et al (2018) S3 guideline: Therapy of type 1 diabetes. German Diabetes Society AWMF-Registry Number: (057-013) 72
6. Schoenenberger R A et al. (2009) Internistic emergencies: Safe through the acute situation and the following 48 hours. Georg Thieme Publisher SS 207-208
7. van Gestel A et al (2010) Physiotherapy for chronic respiratory and lung diseases. Springer publishing house 128