Kussmaul Breathing in Lactic Acidosis
Acute non-cardiopulmonary dyspnoea. 70 ys, DM, vomiting and URQ abdominal pain since 3 days. Recently discharged for acute colecystitis. On arrival, alert, tachypnoeic (see video), BT 37.9*C. On CT scan, abdominal abscess. BGA: severe lactic acidosis 21 mmol/L, gluc 48.
The patient had regularly taken metformin 500mg tid
Treated successfully with IV Bicarb & dialysis. Bottom line. Not every dyspnoea originates in the chest. Kussmaul breathing to compensate for metabolic acidosis
Dr. Roberto Cosentini @rob_cosentini
#Kussmaul #Breathing #Respirations #Clinical #Video #PhysicalExam #Pulmonary #Respiratory
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Abnormalities in Rate and Rhythm of Breathing
Normal
The respiratory rate is about 14—20 per min in normal adults and up to 44 per min in infants.
Rapid Shallow Breathing (Tachypnea)
Rapid shallow breathing has a number of causes, including restrictive lung disease, pleuritic chest pain, and an elevated diaphragm.
Rapid Deep Breathing (Hyperpnea, Hyperventilation)
Rapid deep breathing has several causes, including exercise, anxiety, and metabolic acidosis. In the comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the midbrain or pons.
Kussmaul breathing is deep breathing due to metabolic acidosis. It may be fast, normal or slow.
Slow Breathing (Bradypnea)
Slow breathing may be secondary to diabetic coma, drug-induced respiratory depression, and increased intracranial pressure.
Cheyne-Stokes Breathing
Periods of deep breathing alternate with periods of apnea (no breathing). Children and aging people normally may show this pattern in sleep. Other causes include heart failure, uremia, drug-induced respiratory depression, and brain damage (typically on both sides of the cerebral hemispheres or diencephalon).
Ataxic Breathing (Blot's Breathing)
Ataxic breathing is characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods
Causes include respiratory depression and brain damage, typically at the medullary level.
Sighing Respiration
Breathing punctuated by frequent sighs should alert you to the visibility of hyperventilation syndrome—a common cause of dyspnea and dizziness. Occasional sighs are normal.
Obstructive Breathing
In lung disease, expiration is prolonged because narrowed airways increase the resistance to air flow. Causes include asthma, chronic bronchitis, and COPD.
#Breathing #Patterns #Pulmonary #Abnormalities #Abnormal #Diagnosis #PhysicalExam
Hoover's Sign
Hoover’s sign refers to inward movement of the lower rib cage during inspiration- instead of outward as is normal - implying a flat, but functioning, diaphragm, often associated with COPD. COPD, and more specifically emphysema, often lead to hyperexpansion of the lungs due to air trapping. The resulting flattened diaphragm contracts inwards instead of downwards, thereby paradoxically pulling the inferior ribs inwards with its movement.
#Hoovers #Sign #Pulmonary #COPD #PhysicalExam #Video #Clinical #Breathing #Paradoxical #Respiratory
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