RespiratoryPhysiology

A–a Oxygen Gradient

The alveolar–arterial oxygen gradient separates hypoxemia caused by hypoventilation or low inspired oxygen from hypoxemia caused by V/Q mismatch, diffusion impairment, or shunt. This calculator applies the alveolar gas equation and reports the A–a gradient and a/A ratio with interpretation.

Uses the alveolar gas equation with PH₂O = 47 mmHg. Enter FiO₂ as a percentage (room air = 21). Values must be from the same arterial blood gas.

760 at sea level; lower at altitude

Usually 0.8

Alveolar gas equation. PH₂O = 47 mmHg at body temperature; R ≈ 0.8.

Use with caution in neonates — combine with oxygenation index and echocardiography for shunt physiology.

Frequently asked questions

What is a normal A–a gradient in a newborn?

It rises with FiO₂ and is not firmly established in neonates. A widened gradient suggests V/Q mismatch, shunt, or diffusion impairment rather than hypoventilation.

Why use the a/A ratio?

It is less dependent on FiO₂ than the A–a gradient; a value below about 0.75 suggests impaired gas exchange.

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