Arterial Blood Gas (ABG) Interpretation

  • Ali AltalagEmail author
  • Jeremy Road
  • Pearce Wilcox
  • Kewan Aboulhosn
Part of the In Clinical Practice book series (ICP)


This chapter reviews the fundamentals in acid-base interpretation and the differential diagnosis for each acid-base pattern. We also discuss oxygen transfer physiology and pathophysiology with a final case based illustration of the topic.


Arterial blood gas (ABG) Alkalosis Acidosis A-a gradient Hypoxemia Hypercapnea 


  1. 1.
    Bear RA, Dyck RF. Clinical approach to the diagnosis of acid-base disorders. Can Med Assoc J. 1979;120:173–82.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Kassirer J, Bleich H. Rapid estimation of plasma carbon dioxide tension from pH and total carbon dioxide content. N Engl J Med. 1965;272:1067.CrossRefPubMedGoogle Scholar
  3. 3.
    Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore). 1977;56:38–54.CrossRefGoogle Scholar
  4. 4.
    Lennon E, Lemann JJ. Defense of hydrogen ion concentration in chronic metabolic acidosis. A new evaluation of an old approach. Ann Intern Med. 1966;65:265.CrossRefPubMedGoogle Scholar
  5. 5.
    Narins RG, Emmett M. Simple and mixed acid-base disorders: a practical approach. Medicine (Baltimore). 1980;59:161–87.CrossRefGoogle Scholar
  6. 6.
    Albert MS, Dell RB, Winters RW. Quantitative displacement of acid-base equilibrium in metabolic acidosis. Ann Intern Med. 1967;66:312–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Dubose TD. Acid–base disorders. In: Brenner BM, editor. Brenner and Rector’s The Kidney. 6th ed. Philadelphia, PA: WB Saunders; 2000. p. 925–97.Google Scholar
  8. 8.
    Batlle DC, Hizon M, Cohen E, Gutterman C, Gupta R. The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med. 1988;318:594–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Oliva P. Severe alveolar hypoventilation in a patient with metabolic alkalosis. Am J Med. 1972;52:817.CrossRefPubMedGoogle Scholar
  10. 10.
    Cuomo A, Lifshitz M, Brasch R, Al E. Marked hypercapnia secondary to severe metabolic alkalosis. Ann Intern Med. 1972;177:405.Google Scholar
  11. 11.
    Javaheri S, Kazemi H. Metabolic alkalosis and hypoventilation in humans. Am Rev Respir Dis. 1987;136:1011–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Fulop M. Hypercapnia in metabolic alkalosis. NY State J Med. 1976;76:19.Google Scholar
  13. 13.
    de Strihou VY, Frans A. The respiratory response to chronic metabolic alkalosis and acidosis in disease. Clin Sci Mol Med. 1973;45:439–48.Google Scholar
  14. 14.
    NCJ B, Cohen JJ, Schwartz WB. Carbon dioxide titration curve of normal man. Effect of increasing degrees of acute hypercapnia on acid-base equilibrium. N Engl J Med. 1965;272:6–12.CrossRefGoogle Scholar
  15. 15.
    Schwartz WB, NCJ B, Cohen JJ. The response of extracellular hydrogen ion concentration to graded degrees of chronic hypercapnia: the physiologic limits of the defense of pH. J Clin Invest. 1965;44:291–301.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Arbus GS, Herbert LA, Levesque PR, Etsten BE, Schwartz WB. Characterization and clinical application of the “significance band” for acute respiratory alkalosis. N Engl J Med. 1969;280:117–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Gennari FJ, Goldstein MB, Schwartz WB. The nature of the renal adaptation to chronic hypocapnia. J Clin Invest. 1972;51:1722–30.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Weil JV. Ventilatory control at high altitude. In: Fishman AP, editor. Handbook of physiology. Section 3: the respiratory system. Bethesda, MD: American Physiological Society; 1986. p. 703–27.Google Scholar
  19. 19.
    Goldberg M, Green SB, Moss ML, et al. Computer-based instruction and diagnosis of acid-base disorders: a systematic approach. JAMA. 1973;223:266–75.CrossRefGoogle Scholar
  20. 20.
    Mellemgaard K. The alveolar-arterial oxygen difference: its size and components in normal man. Acta Physiol Scand. 1966;67:10–20.CrossRefPubMedGoogle Scholar
  21. 21.
    West JB. Respiratory physiology: the essentials. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Ali Altalag
    • 1
    Email author
  • Jeremy Road
    • 2
  • Pearce Wilcox
    • 2
  • Kewan Aboulhosn
    • 3
  1. 1.Prince Sultan Military Medical CityRiyadhSaudi Arabia
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.University of British ColumbiaVictoriaCanada

Personalised recommendations