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Lactic acidosis from septic shock — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesLactic acidosis from septic shockSCE Acute Medicine

A shocked patient with pneumonia has lactate 8.4 mmol/L, cool peripheries and oliguria. There is no seizure, metformin exposure or liver failure. What best explains the lactate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Treat septic hypoperfusion while checking lactate clearance

The best answer is “Treat septic hypoperfusion while checking lactate clearance”. This is correct because inadequate oxygen delivery and adrenergic stress in shock increase lactate production, while hepatic dysfunction can reduce clearance. The value is a severity marker and should be trended with perfusion response rather than treated in isolation. The alternative acid–base mechanisms do not match the observed shock physiology.

Reference: NICE NG51 sepsis recommendations: https://www.nice.org.uk/guidance/ng51/chapter/recommendations