Interpretation of Arterial Blood Gases: Review
DOI:
https://doi.org/10.53732/rccsalud/2024.e6302Keywords:
blood gas analysis, physiology oxygenation, alkalosis, acidosisAbstract
Arterial blood gases are fundamental tools to objectively evaluate patients with acute and chronic pathologies. They provide information on rates of oxygenation, ventilation, acid-base balance, and oxygen supply at the cellular level. Interpreting them properly is of great clinical importance for making timely decisions and allows evaluating the response to therapeutic interventions. This article introduces to the reader to the basic concepts of gas exchange physiology, the most common acid-base disorders, and a practical interpretation of arterial blood gases. A combination of graphic illustrations, tables, and algorithms is used to facilitate the understanding and clinical management of patients with respiratory and metabolic disorders.
References
Yee J, Frinak S, Mohiuddin N, Uduman J. Fundamentals of Arterial Blood Gas Interpretation. Kidney360. 2022;3(8):1458-1466. https://doi.org/10.34067/KID.0008102021
Barrett KE, Barman SM, Brooks HL, Yuan JJ, editors. Gas Transport & pH. In Ganong’s Review of Medical Physiology, 26 ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com/content.aspx?bookid=2525§ionid=204297654
DuBose JT. Acidosis and Alkalosis. In Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, editors. Harrison’s Principles of Internal Medicine 20. McGraw Hill; 2022.
Wolf MB. Physicochemical Models of Acid-Base. Semin Nephrol. 2019;39(4):328-339. https://doi.org/10.1016/j.semnephrol.2019.04.003
Kaynar AM: Arterial blood gas interpretation. In: Textbook of Critical Care, edited by Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink PM, 7th Ed., Philadelphia, PA, Elsevier, 2017, pp 167–174.
Woodrow P. Arterial blood gas analysis. Nurs Stand. 2004;18(21):45-52. https://doi.org/10.7748/ns2004.02.18.21.45.c3544
Farmand M. Blood gas analysis and the fundamentals of acid-base balance. Neonatal Netw. 2009;28(2):125-8. https://doi.org/10.1891/0730-0832.28.2.125
Petersson J, Glenny RW. Gas exchange and ventilation-perfusion relationships in the lung. Eur Respir J. 2014;44(4):1023-41. https://doi.org/10.1183/09031936.00037014
Patel S, Jose A, Mohiuddin SS. Physiology, Oxygen Transport And Carbon Dioxide Dissociation Curve. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK539815/
Sharma S, Hashmi MF, Burns B. Alveolar Gas Equation. StatPearls. 2022. https://www.ncbi.nlm.nih.gov/books/NBK482268/
Do C, Vasquez PC, Soleimani M. Metabolic Alkalosis Pathogenesis, Diagnosis, and Treatment: Core Curriculum 2022. Am J Kidney Dis. 2022;80(4):536-551. https://doi.org/10.1053/j.ajkd.2021.12.016
Gomella LG, Haist SA, editors. Blood gases and acid–base disorders. In Clinician’s Pocket Reference: The Scut Monkey. 11th ed.: McGraw Hill; 2007.
O’Driscoll BR, Howard LS, Earis J, Mak V. Briti-sh Thoracic Society Emergency Oxygen Guide-line Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency set-tings. Thorax. 2017;72(1):ii1-ii90. https://doi.org/10.1136/thoraxjnl-2016-209729
Lee WL, Slutsky AS. Acute Hypoxemic Respiratory Failure and ARDS. In Broaddus VC, Ernst J, King KT, Lazarus S, editors. Murray and Nadel’s Textbook of Respiratory Medicine: Elsevier; 2021. p. 1740-1760
Hopkins E, Sanvictores T, Sharma S. Physiology, Acid Base Balance. StatPearls. 2022. https://pubmed.ncbi.nlm.nih.gov/29939584/
Gallo de Moraes A, Surani S. Effects of diabetic ketoacidosis in the respiratory system. World J Diabetes. 2019;10(1):16-22. https://doi.org/10.4239/wjd.v10.i1.16
Langer T, Pelosi PCP. Respiratory Acid-Base Disorders. In Ronco C, Bellomo R, Kellum JA, Ric-ci Z, editors. Critical Care Nephrology: Elsevier; 2019. p. 411-416.e1
Kaynar AM: Arterial blood gas interpretation. In: Textbook of Critical Care, edited by Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink PM, 7th Ed., Philadelphia, PA, Elsevier, 2017, pp 167–174
Narins RG, Emmett M. Simple and mixed acid-base disorders: a practical approach. Medicine (Baltimore). 1980 May;59(3):161-87.
Narins RG, Jones ER, Stom MC, Rudnick MR, Bastl CP: Diagnostic strategies in disorders of fluid, electrolyte and acid-base homeostasis. Am J Med 72: 496–520, 1982.
Hughes JM. Assessing gas exchange. Chron Respir Dis. 2007;4(4):205-14. https://doi.org/10.1177/1479972307084446
Kellum JA. Determinants of blood pH in health and disease. Crit Care. 2000;4(1):6-14. https://doi.org/10.1186/cc644
Tucker AM, Johnson TN. Acid-base disorders: A primer for clinicians. Nutr Clin Pract. 2022;37(5):980-989. https://doi.org/10.1002/ncp.10881
Rodríguez-Villar S, Do Vale BM, Fletcher HM. The arterial blood gas algorithm: Proposal of a systematic approach to analysis of acid-base disorders. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(1):20-34. https://doi.org/10.1016/j.redar.2019.04.001
Gomez H, Kellum JA. Understanding Acid Base Disorders. Crit Care Clin. 2015;31(4):849-860. https://doi.org/10.1016/j.ccc.2015.06.016
Berend K. Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis. Kidney Dis (Basel). 2017;3(4):149-159. https://doi.org/10.1159/000479279
Kraut JA, Nagami GT. The serum anion gap in the evaluation of acid-base disorders: what are its limitations, and can its effectiveness be improved? Clin J Am Soc Nephrol. 2013;8(11):2018-24. https://doi.org/10.2215/CJN.04040413
Matyukhin I, Patschan S, Ritter O, Patschan D. Etiology and Management of Acute Metabolic Acidosis: An Update. Kidney Blood Press Res. 2020;45(4):523-531. https://doi.org/10.1159/000507813
Emmett M. Review of Clinical Disorders Causing Metabolic Acidosis. Adv Chronic Kidney Dis. 2022;29(4):355-363. https://doi.org/10.1053/j.ackd.2022.07.004
Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, et al. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care. 2019;9(92):1-17. https://doi.org/10.1186/s13613-019-0563-2
Fenves AZ, Emmett M. Approach to Patients with High Anion Gap Metabolic Acidosis: Core Curriculum 2021. Am J Kidney Dis. 2021;78(4):590-600. https://doi.org/10.1053/j.ajkd.2021.02.341
Lentz SA, Ackil D. Metabolic Acid-Base Disorders. Emerg Med Clin North Am. 2023;41(4):849-862. https://doi.org/10.1016/j.emc.2023.06.008
Sanghavi S, Albert TJ, Swenson ER. Acid-Base Balance. In Broaddus VC, Ernst J, King KT, La-zarus S, editors. Murray & Nadel’s Textbook of Respiratory Medicine: Elsevier; 2021. p. 154-167.
Kelen GD, Nicolaou DD, Cline DM. Acid-Base Disorders. In Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide: McGraw Hill; 2016.
Gomella LG, Haist SA, editors. Blood gases and acid–base disorders. In Clinician’s Pocket Refe-rence: The Scut Monkey. 11th ed.: McGraw Hill; 2007
Emmett M. Metabolic Alkalosis: A Brief Pathophysiologic Review. Clin J Am Soc Nephrol. 2020;15(12):1848-1856. https://doi.org/10.2215/CJN.16041219
Seifter JL. Acid-Base Disorders. In Goldman L, Schafer A, editors. Goldman-Cecil Medicine.: Elsevier; 2016. p. 762-774.
Krapf R, Beeler I, Hertner D, Hulter HN. Chronic respiratory alkalosis. The effect of sustained hyperventilation on renal regulation of acid-base equilibrium. N Engl J Med. 1991;324(20):1394-401. https://doi.org/10.1056/NEJM199105163242003
Khanna A, Kurtzman NA. Metabolic alkalosis. J Nephrol. 2006 Mar-Apr;19 Suppl 9:S86-96.
Park M, Sidebotham D. Metabolic alkalosis and mixed acid-base disturbance in anaesthesia and critical care. BJA Educ. 2023;23(4):128-135. https://doi.org/10.1016/j.bjae.2023.01.002
Tinawi M. Pathophysiology, Evaluation, and Management of Metabolic Alkalosis. Cureus. 2021;13(1):e12841. https://doi.org/10.7759/cureus.12841
Gledhill N, Beirne GJ, Dempsey JA. Renal response to short-term hypocapnia in man. Kidney Int. 1975;8(6):376-84. https://doi.org/10.1038/ki.1975.130
Elkinton JR, Huth EJ, Webster GD Jr, McCANCE RA. The renal excretion of hydrogen ion in renal tubular acidosis. I. quantitative assessment of the response to ammonium chloride as an acid load. Am J Med. 1960;29(4):554–75. https://doi.org/10.1016/0002-9343(60)90090-5
Brinkman JE, Sharma S. Respiratory Alkalosis. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK482117/
Seifter JL. Integration of acid-base and electrolyte disorders. N Engl J Med.
;372(4):391-2. https://doi.org/10.1056/NEJMc1414731
Palmer BF, Clegg DJ. Respiratory Acidosis and Respiratory Alkalosis: Core Curriculum 2023. Am J Kidney Dis. 2023;82(3):347-359. https://doi.org/10.1053/j.ajkd.2023.02.004
Johnson RA. A Quick Reference on Respiratory Alkalosis. Vet Clin North Am Small Anim Pract. 2017;47(2):181-184. https://doi.org/10.1016/j.cvsm.2016.10.005
Batlle DC, von Riotte A, Schlueter W. Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. N Engl J Med. 1987;316(3):140-4. https://www.nejm.org/doi/full/10.1056/NEJM198701153160305
Rodriguez Soriano J, Boichis H, Stark H, Edelmann CM Jr. Proximal renal tubular acidosis. A defect in bicarbonate reabsorption with normal urinary acidification. Pediatr Res. 1967;1(2):81-98. https://doi.org/10.1203/00006450-196703000-00001
Oh M, Carroll HJ. Value and determinants of urine anion gap. Nephron. 2002;90(3):252-5. https://doi.org/10.1159/000049059
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