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Old 03-07-2011, 12:19 AM
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Default Tx for Kussmaul's Respirations?

So I understand this to be deep rapid respirations, as part of the signs of DKA. It's a result of the acidosis, and a need for air... so the body rapidly tries to expel CO2.

Right?

So... how on earth do you treat the respirations? I do understand you would need to treat the acidosis, but the question on my study guide says to know how to treat Kussmaul's Respirations.

A class mate told me with a brown paper bag? That doesn't seem complicated enough to me, and I can't find anything in my book about it.
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Old 03-07-2011, 02:04 AM
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You have to treat the acidosis first and if that doesn't correct it--Intubation. I don't know Sarah usually when they get to that point they are on their way out.
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Old 03-07-2011, 05:56 AM
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Your classmate is confusing Kussmaul's with hyperventalation, which is caused by breathing too deeply and/or quickly. Hyperventalating leads to the UNINTEDED loss of of too MUCH CO2, leading to dizziness and tingling of extremities. That treatment IS the brown paper bag or breathing into cupped hands to rebreath in more CO2. This occurs with overexcitment or during labor with controlled breathing patterns (like Lamaze).

As you said, Kussmaul's is an attempt to reverse metabolic acidosis by blowing off Bicarb as a compensatory effort. These are spontaneous and under autonamic control, so you can NOT "treat the respirations" any more than you can help a patient "control" full blown labor contractions or autonamic dysreflexia in a pt with spinal cord injury.

So, as TNN said, the treatment is to control the underlying metabolic issue with meds, fluids, mechanical oxygenation if needed. Th pH has to brought up to a level compatable with human life.
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Old 03-07-2011, 12:45 PM
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Ok, so that puts me back to square one then with this because my study guide has the question:

"Describe treatment of Kussmaul's Respirations with DKA."

So then would you guys say that you need to treat the acidosis? See, this is what confuses me because when I think of treating something, I am thinking that they are deep and rapidly breathing and that it takes a lot longer to treat the source of acidosis than it will to stop these ventilations.

Actually, after thinking about this more last night, I thought if the body was trying to expel Co2, then rebreathing techniques would make the situation worse? yes?

I do agree with TNN, that this is a sign that the patient is on the way out. I did read that. So I guess I am not sure I am understanding what the study guide is asking me to know.

I wonder if it is quite as simple as saying to treat the source of acidosis? Would applying O2 help in any way?
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Old 03-07-2011, 03:18 PM
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I am not sure what the "textbook" answer is. I agree with the above posters though the correct clinical answer would be to correct the underlying acidosis. If DKA rehydrate aggressively then start insulin.

The body is trying to compensate by breathing quickly. A lot of people will get in trouble by trying to treat or stop the body's compensation to a stressor--you can end up doing a lot of harm this way.
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Old 03-07-2011, 04:36 PM
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So, my text book actually says nothing about treating the Kussmaul's breathing specifically. It only mentions it as a sign of DKA and the physiology behind it, which is how I came to the conclusion that re-breathing CO2 would be a bad idea...

So, is it safe to say I should consider the answer to this question to treating the acidosis in order to treat the Kussmaul's breathing?

This is all my pre-lecture preparations, it's possible she may go over it on Thursday. I try to have the study guide and readings for the topic completed before lecture. I'm just trying to understand this... and I think I do... lol
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Old 03-07-2011, 05:00 PM
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Treating DKA means medical intervention. It's important to treat dehydration by replacing fluids that have been lost, so most likely IV therapy will be used. Electrolyte imbalances need to be corrected and insulin therapy started to control hyperglycemia.
Ensure a patent airway, and begin to administer oxygen via nasal cannula or mask. Establish an intravenous access. Begin fluid stabilization with 0.9 Normal Saline ( unless MD prescribes for something else ). This is an isotonic fluid, compatible with the body's pH. The purpose of using an isotonic infusion initially is to re-establish blood pressure which was low and to increase urinary out put to 30-60ml/hr. When urinary output is less than 30 ml/hr, kidney failure may happen. Fluids should continue until stabilization occurs. The docotr may also order insulin infusion with a drip rate. During this time monitor the person's vital signs every fifteen minutes until stable or for at least one hour after treatment begins or per facility policy. If necessary, potassium may be be administered to correct for hypokalemia, and sodium bicarbonate to correct for metabolic acidosis, if the pH is less than 7.0. You may also be doing blood glucose monitoring every hour or per facility policy.
During fluid replacement, monitor your patient for signs and symptoms of fluid overload especially if the person is elderly, a child, or at risk for heart failure. Signs and symptoms of heart failure include pulmonary crackles, labored respirations, hypotension, tachycardia, and heart sounds.
Before starting the insulin infusion, don't forget to flush the tubing with 50 ml of insulin solution to saturate the tubing with insulin. Remember, insulin adheres to I.V. tubing, so if you don’t saturate it with insulin, your patient won’t receive the full insulin dose. And I think they are also placed on a heart monitor too. I think this covers it, at least as far as memory goes.
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Old 03-07-2011, 05:07 PM
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Yep. That about covers the Tx for DKA. I have all that info in the book and in my Saunder's review. I found more than enough between the two. It was just strange the way my study guide from the instructor asked specifically about how to treat Kussmaul's Respirations. :/

I will just have to ask what she means on Thursday in class.

Thanks a bunch all! It helped to talk it out tons!
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Old 03-07-2011, 05:09 PM
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Yeah, you have to treat the underlying disorder. So you have to stop the body from using fat for energy which is causing the patient to become acidotic. Address the problem and everything else (Kussmaul respirations) will resolve.

Years ago everyone having a stroke would come in with a high bp and the first thing we would do is give procardia to get the blood pressure to come down quickly. Well what was happening is that the patients (this happened to my grandmother just a few years ago /sigh small hospitals) would get worse. The increased blood pressure was needed to perfuse the brain so when the bp decreased, so did blood going to the brain. If someone was having a hemorrhagic stroke then you would be more aggressive of course.
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Old 03-07-2011, 05:13 PM
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I see what you are saying, and it makes complete sense.

What exactly does Kussmaul's breathing look like? I've just read the description. Would the patient be doing these deep and rapid breaths for hours? days? weeks?

That's also part of what is confusing me because I am thinking patient comfort as well I suppose.
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