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Lactate Clearance Sepsis Resuscitation — FRCA Final MCQ

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ModerateIntensive Care MedicineLactate Clearance Sepsis ResuscitationFRCA Final

A 55-year-old man (ASA III) is on ICU with septic shock. His initial lactate was 6.5 mmol/L. After 6 hours of appropriate management (antibiotics, source control, 30 mL/kg crystalloid, noradrenaline titrated to MAP ≥65), his lactate is 5.8 mmol/L (11% reduction). According to SSC guidelines, what is the significance of the lactate trend?

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Correct answer: D — Lactate clearance of >10% is adequate – continue current management

The SSC guidelines (2021) recommend targeting a lactate clearance of ≥10% every 2 hours during sepsis resuscitation. An 11% reduction in 6 hours demonstrates some clearance but may indicate suboptimal progress. The 2021 guidelines recommend measuring lactate at least every 2 hours and titrating resuscitation efforts to normalise lactate. However, this patient has achieved >10% clearance overall, which suggests some response to treatment. Persistent lactate elevation >2 mmol/L should prompt reassessment of volume status, cardiac function, and source control adequacy.

Reference: SSC – 2021 – International guidelines for sepsis management