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Vasopressor Initiation in Septic Shock — RACP Adult Medicine MCQ

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EasyInfectious DiseasesVasopressor Initiation in Septic ShockRACP Adult Medicine

A 60-year-old woman with septic shock from pyelonephritis remains hypotensive (MAP 58 mmHg) despite 30 mL/kg IV crystalloid (2.5 L). Lactate is 5.2 mmol/L. She is on appropriate antibiotics. What is the most appropriate next step?

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Correct answer: D — Commence noradrenaline infusion

Persistent hypotension (MAP <65 mmHg) despite adequate fluid resuscitation defines septic shock and is the trigger for vasopressor initiation. Noradrenaline is the first-line vasopressor in septic shock (SSC 2021 strong recommendation). Target MAP ≥65 mmHg. If MAP target not achieved on noradrenaline alone, vasopressin (up to 0.03 U/min) is added as second-line.

Reference: Surviving Sepsis Campaign 2021; eTG Antibiotic 2025