Fluids: normal saline complication: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Fluids: normal saline complication

Sample item

A patient receives several litres of 0.9 percent saline during major surgery. Which acid-base disturbance can develop?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Hyperchloraemic metabolic acidosis

Normal saline has 154 mmol/L chloride, which exceeds plasma levels, and large volumes lower the strong ion difference and cause hyperchloraemic metabolic acidosis. Balanced solutions such as Ringer lactate contain lower chloride and are preferred for large-volume replacement. Saline is still the fluid of choice in hypochloraemic alkalosis from vomiting.

Option by option

  • A. Hypochloraemic acidosis

    The acidosis is hyperchloraemic, not hypochloraemic.

  • B. Metabolic alkalosis

    Saline does not produce alkalosis in this setting.

  • C. Respiratory alkalosis

    Respiratory alkalosis is a ventilatory problem.

  • D. Hyperchloraemic metabolic acidosis (correct)

    Correct. Excess chloride causes a normal anion gap acidosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Hyperchloraemic metabolic acidosis. Normal saline has 154 mmol/L chloride, which exceeds plasma levels, and large volumes lower the strong ion difference and cause hyperchloraemic metabolic acidosis.

Why is "Hypochloraemic acidosis" not the answer?

The acidosis is hyperchloraemic, not hypochloraemic.

Why is "Metabolic alkalosis" not the answer?

Saline does not produce alkalosis in this setting.

Why is "Respiratory alkalosis" not the answer?

Respiratory alkalosis is a ventilatory problem.

What concept does this question test?

It tests Fluids: normal saline complication in General Surgery. Balanced solutions such as Ringer lactate contain lower chloride and are preferred for large-volume replacement. Saline is still the fluid of choice in hypochloraemic alkalosis from vomiting.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fluids: normal saline complication?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.