Nasal Flaring in an Unconscious Child With Severe Malaria: Compensation Reflex for Metabolic Acidosis

Kussmaul breathing is a clinical sign of metabolic acidosis. Inspiratory flaring of the alae nasi may accompany these respirations, enhancing compensatory CO2 exhalation. We describe a child with severe falciparum malaria, coma, and metabolic acidosis. We discuss a ventilatory reflex, localized in the brainstem, which senses rising H+/CO2, and leads to a compensatory coordinated unconscious response, which includes nasal flaring.