I have seen many junior Anesthesiologists prefer giving normal saline intra-operatively. But are they aware that there's nothing "Normal" about Normal saline. Let me explain. Normal values of osmolarity of blood ranges from 275 to 295 mmol/kg ( 275- 295 mOsm/kg). And sodium concentration in plasma is usually maintained between 137 to 142 mEq/L.

Interestingly, Normal saline contains 154 mEq/L sodium as well as chloride and has an osmolarity of 308 mOsm/L. Obviously, with a strong ion difference, normal saline produces or worsens metabolic acidosis . Rapid isotonic saline infusion can result hyperchloremic acidosis. BTW, this acidosis is due to a reduction in the anion gap and excessive increase in plasma chloride and excessive renal bicarbonate elimination. Wishing you all a happy Doctor's Day!