What is the role of arterial blood gas (ABG) measurement in the workup of alcoholic ketoacidosis (AKA)?

Updated: Aug 27, 2020
  • Author: George Ansstas, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Arterial blood gas (ABG) measurement may show a low pCO2 level, low bicarbonate level, and normal partial pressure of oxygen (pO2) level. The pattern is consistent with a metabolic acidosis with a respiratory compensation.

Serum pH levels may be misleading because the patient with AKA often has a mixed acid-base disorder. In addition to metabolic acidosis due to ketone formation, a metabolic alkalosis may be present due to vomiting and volume depletion. [7] A respiratory alkalosis may be present secondary to hyperventilation. The possibility of a double or triple acid-base disorder means serum pH levels may be near normal despite a severe acid-base disturbance.

A compensatory respiratory alkalosis alone cannot correct the pH to normal, because the drive for compensation decreases as the pH approaches normality. This implies that a significant noncompensatory metabolic alkalosis also must be present if the pH is near the normal range.

Venous blood gas measurements correlate very well with arterial measurements. One should consider using venous blood gas measurements in lieu of arterial blood gas measurements. [23]

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