Acid-Base Simplified

The arterial blood gas is on the screen, the patient is hypotensive, the lactate is rising, and the resident at the bedside has ninety seconds to translate four numbers into a diagnosis and a plan.
Reflexive bicarbonate in lactic acidosis, saline-driven hyperchloremic acidosis stacked on sepsis, missed salicylate toxicity hiding behind a normal pH, COPD baselines mistaken for acute decompensation — the cost of slow or pattern-based ABG interpretation is paid by the patient in the next bed.
This book builds the systematic discipline that turns four numbers on an ABG into a defensible clinical decision in under two minutes.
Inside this book:
• Stepwise ABG interpretation — apply the same five-step sequence to every blood gas, from textbook DKA to triple-disorder ICU patients
• Anion gap and delta-delta mastery — catch the mixed disorders that pattern recognition misses, including the salicylate signature most clinicians miss on first read
• GOLD MARK and MUDPILES applied — move from elevated gap to confirmed etiology with a tiered workup that runs in real time
• Bicarbonate decisions, evidence-based — know exactly when sodium bicarbonate helps, when it harms, and what BICAR-ICU actually changed
• RTA recognition that adults miss — distinguish type 1, type 2, and type 4 by urine signature and clinical context, not memorized lists
• Balanced crystalloid integration — apply SMART, SALT-ED, and PLUS trial evidence to every resuscitation decision
• Toxic alcohol and salicylate management — recognize the mixed pattern, calculate the osmolar gap, and trigger fomepizole or dialysis without delay
Written for internal medicine residents, hospitalists, nurse practitioners and physician assistants in acute and critical care, emergency medicine trainees, and medical students entering the clinical years.
Read it before the next blood gas resists easy interpretation — because at three in the morning, the framework is what carries you.