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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