The World’s Okayest Medic Podcast Dan Rauh: Really Sick Acidotic Patients
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Jun 12, 2025 
Dan Rauh is a nurse practitioner, paramedic, and intensivist with a rich background in emergency care. He sheds light on the importance of recognizing acidosis in patients, stressing better educational practices for healthcare providers. Rauh critiques the traditional use of bicarbonate in treating severe acidosis and encourages a deeper understanding of blood gas interpretation. He also discusses the complexities of managing emergency medications during crises, highlighting key decision-making strategies for improved patient outcomes.
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Use BMP Bicarb for Acidosis
- Look at the BMP bicarb (expressed as CO2) to evaluate metabolic acidosis.
- Understand that blood gas bicarb is calculated and less reliable than BMP bicarb.
Bicarb Push Produces CO2
- Giving bicarbonate IV push can worsen acidosis by producing CO2.
- CO2 accumulation causes respiratory acidosis if lungs cannot eliminate it effectively.
Bicarbonate Pushes: Use Judiciously
- Use bicarbonate pushes only to break the crashing acidosis cycle and buy time for other therapies.
- Prefer bicarbonate infusion drips over pushes to avoid rapid CO2 increase.