A 58-year-old man admitted with faecal peritonitis has been given 30 mL/kg of crystalloid. He remains hypotensive and needs norepinephrine at 0.15 mcg/kg/min to hold MAP at 68 mmHg. Arterial lactate is 3.1 mmol/L. According to the Sepsis-3 definitions, what is the correct classification?

• A Septic shock ✓
• B Sepsis without shock
• C Severe sepsis
• D Refractory distributive shock

Explanation

Sepsis-3 defines septic shock as sepsis with persisting hypotension that requires a vasopressor to maintain MAP at or above 65 mmHg AND a lactate above 2 mmol/L despite adequate volume resuscitation. This patient meets both criteria. The term 'severe sepsis' was abolished in Sepsis-3, so option C uses obsolete terminology rather than describing a separate state.

Reference: Sabiston Textbook of Surgery, 21st ed.

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