84. Acid Base Made Easy with Dr Sara Crager

Returning guest Dr. Sara Crager joins us again on Critical Care Time, this time to tackle one of the most important, and most commonly overcomplicated, topics in critical care: acid–base physiology. Rather than treating acid–base as a collection of equations and compensation formulas, Sara walks us through her practical State → Process → Story framework for rapidly interpreting blood gases and electrolytes at the bedside. We discuss how to distinguish acidemia from acidosis, interpret CO₂ in the context of bicarbonate, use the anion gap and strong ion difference to uncover mixed metabolic disorders, recognize the importance of chloride and albumin, and understand why a “normal” pH—or a “normal” CO₂—may be anything but normal. Along the way, we work through several real-world ICU cases involving chronic hypercapnia, DKA, vomiting, septic shock, renal failure, saline-induced hyperchloremia, and hypoalbuminemia. The goal isn’t more acid–base math. It’s a better mental model and a faster way to understand what your patient’s numbers are actually telling you.

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