_id

683a15fac782e11e38d1b0eb

id

1741

title

Arterial Blood Gas (ABG) Analyzer

full_title

Arterial Blood Gas (ABG) Analyzer

short_title

ABG Analyzer

med_description

Interprets ABG.

short_description

Interprets ABG.

slug

arterial-blood-gas-abg-analyzer

description

The Arterial Blood Gas (ABG) Analyzer interprets ABG findings and values.

keywords

Arterial Blood Gas (ABG) Analyzer, ABG analyzer, abg calc, ABG calc, abg calculator, blood gas calculator, abg interpretation, abg score, blood gas analyzer, blood gas interpret, blood gas calc, blood gas score, blood gas mdcalc, abg analyze, abg analysis, arterial gas calc, arterial blood calc, arterial blood analysis, arterial gas analyzer, acidosis analyzer, base analyzer, albumin analyzer, ph anazlyer abg, ph analyzer.

complaint

[ "Diarrhea", "Intoxication/Overdose", "Shortness of Breath" ]

formula

This tool, developed byJonathan Chen, MDfirst determines the primary process by looking at the pH and the PCO2. It then calculates compensations to determine chronicity, compensatory, and co-existing acid-base disturbances. These calculations use the following normal values: Arterial pH: 7.40 PaCO2: 40 mmHg HCO3-: 24 mEq/L Albumin: 4.0 g/dL Anion gap: 12 mEq/L

evidence

measurements

[ { "name": "Bicarbonate", "unit": "bicarb", "error_min": "1", "error_max": "100", "warn_min": "4", "warn_max": "60", "conversion": "1", "normal_max_si": "28", "normal_max_us": "28", "normal_min_si": "23", "normal_min_us": "23", "units_si": "mmol/L", "units_us": "mEq/L" }, { "name": "Chloride", "unit": "cl", "error_min": "70", "error_max": "130", "warn_min": "80", "warn_max": "120", "conversion": "1", "normal_max_si": "106", "normal_max_us": "106", "normal_min_si": "98", "normal_min_us": "98", "units_si": "mmol/L", "units_us": "mEq/L" }, { "name": "Partial Pressure of CO2", "unit": "paco2", "error_min": "1", "error_max": "150", "warn_min": "10", "warn_max": "60", "conversion": "0.133", "normal_max_si": "5.586", "normal_max_us": "42", "normal_min_si": "5.054", "normal_min_us": "38", "units_si": "kPa", "units_us": "mm Hg" }, { "name": "Sodium", "unit": "na", "error_min": "100", "error_max": "200", "warn_min": "0", "warn_max": "170", "conversion": "1", "normal_max_si": "145", "normal_max_us": "145", "normal_min_si": "136", "normal_min_us": "136", "units_si": "mmol/L", "units_us": "mEq/L" }, { "name": "pH", "unit": "ph", "error_min": "6.2", "error_max": "8.5", "warn_min": "7", "warn_max": "7.6", "conversion": "1", "normal_max_si": "7.44", "normal_max_us": "7.44", "normal_min_si": "7.38", "normal_min_us": "7.38", "units_si": "", "units_us": "" }, { "name": "Albumin (General)", "unit": "alb", "error_min": "0", "error_max": "7", "warn_min": "1", "warn_max": "6", "conversion": "10", "normal_max_si": "55", "normal_max_us": "5.5", "normal_min_si": "35", "normal_min_us": "3.5", "units_si": "g/L", "units_us": "g/dL" } ]

information

Metabolic Acidosis (Anion Gap)

MUDPILES

• Methanol
• Uremia
• Diabetic Ketoacidosis (check serum ketones)
• Propylene Glycol or Paraldehydes
• Isoniazid
• Lactic Acidosis (check serum lactate)
• Ethylene Glycol (anti-freeze)
• Salycylates

GOLDMARK

• Glycols (ethylene or propylene)
• Oxoporin (reflects fatty liver damage from glutathione consumption, e.g. acetaminophen toxicity)
• L-Lactate
• D-Lactate (bacterial form)
• Methanol
• Aspirin (salicylate)
• Renal Failure (BUN uremia)
• Ketoacidosis

Metabolic Acidosis (Non-Anion Gap)

GI Loss

• Diarrhea / Laxatives
• Fistula, (pancreatic, biliary)
• Uretero-intestinal diversion (ileal conduit)

Renal Loss

• Renal Tubular Acidosis (Type 1 Distal or Type 2 Proximal)
• Renal Failure
• Hyper-kalemia

Exogenous Acid

• HCl
• Amino Acids

FUSED CARS

• Fistula (pancreatic, biliary)
• Uretero-gastric conduit
• Saline admin (dilutional acidosis)
• Endocrine (hyper-PTH)
• Diarrhea
• Carbonic anhydrase inhibitor (acetazolamide)
• Ammonium chloride
• Renal tubular acidosis
• Spironolactone

Metabolic Alkalosis

Alkaline Input

• Bicarbonate Infusion
• Hemodialysis
• Calcium Carbonate
• Parenteral Nutrition

Proton Loss

• GI Loss (vomiting, NG suction)
• Renal loss
• Diuretics
• Mineralocorticoids

Respiratory Acidosis

Airway Obstruction

• Foreign body, aspiration
• OSA (obstructive sleep apnea)
• Laryngo- or broncho-spasm

Neuromuscular

• Myasthenia gravis
• Hypokalemic periodic paralysis
• Guillain-Barre
• Botulism, Tetanus
• Hypo-kalemia, hypo-phosphatemia
• Cervical spine injury
• Morbid obesity
• Polio, MS, ALS

Central

• Drugs (opiates, sedatives)
• Oxygen treatment in acute hypercapnia
• Brain trauma or stroke

Pulmonary

• Pulmonary edema
• Asthma
• Pneumonia
• ARDS
• COPD
• Pulmonary Fibrosis
• Mechanical Ventilation

Respiratory Alkalosis

Hypoxia

• High altitude
• CHF
• Pulmonary Embolism

Lung Disease

• Pulmonary fibrosis
• Pulmonary edema
• Pneumonia

Drugs

• Progesterone
• Nicotine

Stimulation of Respiratory Drive

• Psychogenic
• Neurologic (pontine tumor)
• Sepsis
• Pregnancy
• Mechanical ventilation

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://thorax.bmj.com/content/63/3/289.extract", "text": "Baillie JK. Simple, easily memorised 'rules of thumb' for the rapid assessment of physiological compensation for respiratory acid-base disorders. Thorax 2008;63:289-290 doi:10.1136/thx.2007.091223" } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/books/NBK138661/", "text": "WHO Guidelines Arterial Blood Sampling: This 2014 source explains best practices for adequate ABG sampling. WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organization; 2010. 5, Arterial blood sampling." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/36176645/", "text": "Fundamentals of Arterial Blood Gas Interpretation: This 2022 source provides an up-to-date systematic approach to analyzing ABG. Yee, J., Frinak, S., Mohiuddin, N., & Uduman, J. (2022). Fundamentals of Arterial Blood Gas Interpretation. Kidney360, 3(8), 1458–1466." } ], "Outcomes": [], "Validation": [ { "href": "https://www.thoracic.org/clinical/critical-care/clinical-education/abgs.php", "text": "Kaufman DA. Interpretation of Arterial Blood Gases (ABGs). Written for Thoracic.org. Retrieved 12/9/2014." } ], "Validations": [] }

pearls

While the analyzer can often help with analysis, the history of the patient is critical for accurate interpretation.

usecase

• ABG analysis is useful when diagnosing or monitoring various respiratory, metabolic, and circulatory disorders.
• If a respiratory process is present, ABG analysis can help indicate if the process is acute or chronic. 

reasons

The ABG analysis is a systematic approach that, when used in conjunction with patient history and clinical scenario, helps to determine the primary disease process and subsequently calculate any evidence of compensatory process. It also can aid in determining the chronicity of the acid-base disturbance along with any secondary or co-existing acid-base disturbances.

next_advice

• Technique matters when it comes to collecting the blood specimen.
• Inaccurate results may be due to obtaining a venous sample instead of an arterial sample, the presence of air bubbles in the specimen (lowering PaCO₂), or a delay in analyzing the sample (lowering PaO₂). 

next_actions

1. Ensure proper sampling of blood specimen.

2. Consider repeating ABG if results do not fit the patient history and clinical scenario. 

3. A venous blood gas (VBG) can also be checked to see if it correlates with ABG results (only PaO₂ should be different).

next_management

Management varies significantly depending on the ABG results, along with the clinical scenario.

diseases

[ "Acid-Base Disturbance", "Anxiety", "Asthma", "Burns", "Drug/Alcohol Use", "Ingestion/Overdose", "Pulmonary Embolism", "Renal Failure", "Trauma", "Chronic Obstructive Pulmonary Disease" ]

input_schema

[ { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>pH</p>", "name": "ph", "optional": false, "tips_en": "", "type": "textbox", "unit": "ph" }, { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>PₐCO₂</p>", "name": "paco2", "optional": false, "tips_en": "", "type": "textbox", "unit": "paco2" }, { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>HCO₃-</p>", "name": "hco3", "optional": false, "tips_en": "", "type": "textbox", "unit": "bicarb" }, { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Sodium</p>", "name": "sodium", "optional": false, "tips_en": "", "type": "textbox", "unit": "na" }, { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Chloride</p>", "name": "chloride", "optional": false, "tips_en": "", "type": "textbox", "unit": "cl" }, { "conditionality": null, "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Albumin</p>", "name": "albumin", "optional": false, "tips_en": "NOTE: Normal albumin levels are typically 4 g/dL in US units and 40 g/L in SI units.", "type": "textbox", "unit": "alb" }, { "conditionality": null, "default": null, "label_en": "<p>If respiratory process present, chronicity</p>", "mdcalc_info_concept": null, "name": "chronicity", "option_fhir_rules": null, "optional": true, "options": [ { "label": "Acute", "value": 1 }, { "label": "Chronic", "value": 2 } ], "show_points": false, "tips_en": "", "type": "radio" } ]

instructions

This analyzer should not substitute for clinical context. Sodium and chloride are required for anion gap calculation.

published

2022-04-21T20:29:00.148Z

purpose

[ "Formula" ]

search_terms

[ "gas", "vbg", "ph", "acid", "base", "sodium", "chloride", "acidosis", "alkalosis" ]

seo

{ "keywords_en": "Arterial Blood Gas (ABG) Analyzer, ABG analyzer, abg calc, ABG calc, abg calculator, blood gas calculator, abg interpretation, abg score, blood gas analyzer, blood gas interpret, blood gas calc, blood gas score, blood gas mdcalc, abg analyze, abg analysis, arterial gas calc, arterial blood calc, arterial blood analysis, arterial gas analyzer, acidosis analyzer, base analyzer, albumin analyzer, ph anazlyer abg, ph analyzer.", "meta_description_en": "The Arterial Blood Gas (ABG) Analyzer interprets ABG findings and values." }

specialty

[ "Critical Care", "Emergency Medicine", "Endocrinology", "Gastroenterology", "Hospitalist Medicine", "Internal Medicine", "Nephrology", "Pulmonology", "Surgery (General)", "Surgery (Trauma)", "Toxicology" ]

departments

[ "Endocrine and Metabolic", "Gastrointestinal", "Renal", "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1669, "short_title_en": "Anion Gap", "slug": "anion-gap" }, { "calcId": 27, "short_title_en": "Bicarbonate Deficit", "slug": "bicarbonate-deficit" }, { "calcId": 117, "short_title_en": "Winters' Formula", "slug": "winters-formula-metabolic-acidosis-compensation" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "endocrine", "gastroenterology", "urology", "pulmonology" ]

cleaned_use

[ "ABG analysis is useful when diagnosing or monitoring various respiratory, metabolic, and circulatory disorders.", "If a respiratory process is present, ABG analysis can help indicate if the process is acute or chronic." ]

pub

false