The word gradient is a misnomer, and ideally, it should be referred to as A-a oxygen difference as the difference between alveolar and arterial oxygen is not due to any diffusion gradient. ![]() ![]() Therefore, hypoxemia due to V/Q mismatch, diffusion limitation, and shunt will have widened gradient, whereas hypoxemia due to hypoventilation would have normal gradient. Pathology of the alveolocapillary unit widens the gradient. The A-a oxygen gradient indicates the integrity of the alveolocapillary membrane and effectiveness of gas exchange. ![]() It is the difference between alveolar oxygen level (PAO 2) and arterial oxygen level (PaO 2) and is represented by the following equation: Alveolar to arterial (A-a) oxygen gradient = PAO 2 – PaO 2.
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