Kussmaul breathing is commonly associated with various types of a chemical imbalance called metabolic acidosis. Among people with diabetes, Kussmaul breathing most often occurs with diabetic ketoacidosis (DKA). When the body lacks insulin and cannot use glucose for energy, it begins to break down fats to use for energy, producing a toxic waste product called ketones. Ketones raise the acidity of the blood, which may cause metabolic acidosis and Kussmaul breathing.

Several other conditions may cause metabolic acidosis and Kussmaul breathing. They include:

• Excessive lactic acid. Lactic acid is a byproduct of metabolism and is present in blood and muscle tissue of the body. Lactic acidosis (a buildup of lactic acid in the body) is a type of metabolic acidosis that can have a variety of causes, including lack of oxygen (e.g., during shock), extensive exercise, seizures, low blood sugar (hypoglycemia), certain medications and liver failure. This condition can cause patients to experience Kussmaul breathing.
  
  
• Kidney or liver disease. The kidneys and liver filter and remove potentially harmful chemicals and waste products from the body. When these organs fail to function properly, acid may build up in the blood. Distal renal tubular acidosis and proximal renal tubular acidosis are two types of metabolic acidosis caused by kidney problems.

  

• Severe diarrhea. During severe diarrhea, patients may lose fluids, nutrients and certain chemicals that help neutralize acids in the blood. When this loss is significant, it can lead to increased acidity of the blood. For example, hyperchloremic acidosis is a type of metabolic acidosis that can occur during severe bouts of diarrhea.
  
  
• Alcohol abuse. Blood acidity may be elevated in patients who drink excessive amounts of alcohol and who experience malnutrition or severe vomiting that may occur in conjunction with alcohol abuse or sudden withdrawal of alcohol. Alcoholic ketoacidosis occurs due to a combination of factors, such as an increase in ketones in the body (due to periods of prolonged starvation, when the body burns fat instead of glucose for energy), dehydration (due to vomiting) and the consumption of ethanol, a chemical substance in alcohol that is toxic when consumed in excessive amounts.
  
  
• Drugs, medications, toxins. Metabolic acidosis that occurs due to illicit drug use or medication overdose (e.g., excessive aspirin use). Certain chemicals may directly introduce acids into the bloodstream or interfere with the kidneys’ ability to remove acids from the body. This type of metabolic acidosis may also occur due to the ingestion of toxic substances (e.g., antifreeze). In some cases, prescription medications may increase blood acidity as a side effect.
  
  
• Severe dehydration. When dehydration slows blood flow, it can impair the normal balancing of acid-base levels in the blood, and may cause metabolic acidosis.
  
  
• Sepsis (infection in the blood). When sepsis occurs, blood pressure may decrease significantly, and a patient may go into shock. Major organs may not be able to function normally, increasing blood acid levels among other consequences. This is a life-threatening condition.