2016/12/13 AlveolararterialgradientWikipedia

Alveolararterialgradient
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TheAlveolararterialgradient(AaO2,[1]orAa Pathophysiologysamplevalues
gradient),isameasureofthedifferencebetweenthe BMP/ELECTROLYTES:
alveolarconcentration(A)ofoxygenandthearterial(a) Na+=140 Cl=100 BUN=20 /
concentrationofoxygen.Itisusedindiagnosingthesource Glu=150
ofhypoxemia.[2] K+=4 CO2=22 PCr=1.0 \
Ithelpstoassesstheintegrityofalveolarcapillaryunit.For ARTERIALBLOODGAS:
example,inhighaltitude,thearterialoxygenPaO2islow
HCO3=24 paCO2=40 paO2=95 pH=7.40
butonlybecausethealveolaroxygen(PAO2)isalsolow. ALVEOLARGAS:
However,instatesofventilationperfusionmismatch,such pACO2=36 pAO2=105 Aag=10
aspulmonaryembolismorrighttoleftshunt,oxygenisnot OTHER:
effectivelytransferredfromthealveolitothebloodwhich Ca=9.5 Mg2+=2.0 PO4=1
resultsinelevatedAagradient
CK=55 BE=0.36 AG=16
SERUMOSMOLARITY/RENAL:
PMO=300 PCO=295 POG=5 BUN:Cr=20
Contents URINALYSIS:
UNa+=80 UCl=100 UAG=5 FENa=0.95
1 Equation UK+=25 USG=1.01 UCr=60 UO=800
2 Valuesandmeaning PROTEIN/GI/LIVERFUNCTIONTESTS:
3 Seealso
LDH=100 TP=7.6 AST=25 TBIL=0.7
4 References
ALP=71 Alb=4.0 ALT=40 BC=0.5
5 Externallinks
AST/ALT=0.6 BU=0.2
AFalb=3.0 SAAG=1.0 SOG=60
CSF:
Equation CSFalb=30 CSFglu=60 CSF/Salb=7.5 CSF/Sglu=0.4

TheequationforcalculatingtheAagradientis:
[3]

Where:

PAO2=alveolarPO2(calculatedfromthealveolargasequation)

PaO2=arterialPO2(measuredinarterialblood)

Initsexpandedform,theAagradientcanbecalculatedby:

Onroomair(FiO2=0.21,or21%),atsealevel(Patm=760mmHg)assuming100%humidityinthealveoli,
asimplifiedversionoftheequationis:

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Valuesandmeaning
TheAagradientisusefulindeterminingthesourceofhypoxemia.Themeasurementhelpsisolatethelocation
oftheproblemaseitherintrapulmonary(withinthelungs)orextrapulmonary(somewhereelseinthebody).

AnormalAagradientforayoungadultnonsmokerbreathingair,isbetween510mmHg.Normally,theAa
gradientincreaseswithage.Foreverydecadeapersonhaslived,theirAagradientisexpectedtoincreaseby1
mmHg.AconservativeestimateofnormalAagradientislessthan[ageinyears/4]+4.Thus,a40yearold
shouldhaveanAagradientlessthan14.

AnabnormallyincreasedAagradientsuggestsadefectindiffusion,V/Q(ventilation/perfusionratio)
mismatch,orrighttoleftshunt.[4]

BecauseAagradientisapproximatedas:(1505/4(pCO2))PaO2atsealevelandonroomair(0.21x(760
47)=149.7mmHgforthealveolaroxygenpartialpressure,afteraccountingforthewatervapor),thedirect
mathematicalcauseofalargevalueisthatthebloodhasalowPO2,alowPCO2,orboth.CO2isveryeasily
exchangedinthelungsandlowPCO2directlycorrelateswithhighminuteventilationthereforealowarterial
PCO2indicatesthatextrarespiratoryeffortisbeingusedtooxygenatetheblood.AlowPaO2indicatesthatthe
patient'scurrentminuteventilation(whetherhighornormal)isnotenoughtoallowadequateoxygendiffusion
intotheblood.Therefore,theAagradientessentiallydemonstratesahighrespiratoryeffort(lowarterialPCO2)
relativetotheachievedlevelofoxygenation(arterialPO2).AhighAagradientcouldindicateapatient
breathinghardtoachievenormaloxygenation,apatientbreathingnormallyandattaininglowoxygenation,ora
patientbreathinghardandstillfailingtoachievenormaloxygenation.

Iflackofoxygenationisproportionaltolowrespiratoryeffort,thentheAagradientisnotincreasedahealthy
personwhohypoventilateswouldhavehypoxia,butanormalAagradient.Atanextreme,highCO2levels
fromhypoventilationcanmaskanexistinghighAagradient.ThismathematicalartifactmakesAagradient
moreclinicallyusefulinthesettingofhyperventilation.

Seealso
Pulmonarygaspressures

References
1.Logan,CarolynnM.Rice,M.Katherine(1987).Logan'sMedicalandScientificAbbreviations.Philadelphia:J.B.
LippincottCompany.p.4.ISBN0397545894.
2."iROCKETLearningModule:IntrotoArterialBloodGases,Pt.1".Retrieved20081114.
3."AlveolararterialGradient".Retrieved20081114.
4.Costanzo,Linda(2006).BRSPhysiology.Hagerstown:LippincottWilliams&Wilkins.ISBN0781773113.

Externallinks
AaOxygenGradientonlinecalculator(http://www.medicinecalculator.com/aao2gradient/)

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Categories: Respiratoryphysiology
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