Anbarasan C, Sharma A, Kothari N, Meshram TM, Kumari K, Goyal S, Bhatia PK. Impact of magnesium on the clearance of lactate in critically sick patients with sepsis: Randomized clinical trial. World J Crit Care Med 2026; 15(2): 115389 [PMID: 42272874 DOI: 10.5492/wjccm.v15.i2.115389]
Corresponding Author of This Article
Ankur Sharma, MD, Additional Professor, Department of Trauma and Emergency (Anaesthesiology and Critical Care), All India Institute of Medical Sciences, Basni Industrial Area, Jodhpur 342008, Rājasthān, India. ankuranaesthesia@gmail.com
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Anbarasan C, Sharma A, Kothari N, Meshram TM, Kumari K, Goyal S, Bhatia PK. Impact of magnesium on the clearance of lactate in critically sick patients with sepsis: Randomized clinical trial. World J Crit Care Med 2026; 15(2): 115389 [PMID: 42272874 DOI: 10.5492/wjccm.v15.i2.115389]
World J Crit Care Med. Jun 9, 2026; 15(2): 115389 Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.115389
Impact of magnesium on the clearance of lactate in critically sick patients with sepsis: Randomized clinical trial
Chakkaravarthe Anbarasan, Ankur Sharma, Nikhil Kothari, Tanvi M Meshram, Kamlesh Kumari, Shilpa Goyal, Pradeep K Bhatia
Chakkaravarthe Anbarasan, Nikhil Kothari, Tanvi M Meshram, Kamlesh Kumari, Shilpa Goyal, Pradeep K Bhatia, Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, Rājasthān, India
Ankur Sharma, Department of Trauma and Emergency (Anaesthesiology and Critical Care), All India Institute of Medical Sciences, Jodhpur 342008, Rājasthān, India
Author contributions: Anbarasan C prepared the original draft; Sharma A conceptualized and reviewed the draft; Kothari N, Meshram TM, Goyal S, Kumari K, and Bhatia PK reviewed and edited the draft. All authors have read and approved the final manuscript.
Institutional review board statement: Institutional Ethics Committee of AIIMS (All India Institute of Medical Sciences), Jodhpur, Rajasthan, India approval was taken for this trial (approval No. AIIMS/IEC/2022/4177).
Clinical trial registration statement: The study was registered with Clinical Trial Registry - India (No. CTRI/2022/11/047031).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The dataset will be available from the corresponding author on request.
Corresponding author: Ankur Sharma, MD, Additional Professor, Department of Trauma and Emergency (Anaesthesiology and Critical Care), All India Institute of Medical Sciences, Basni Industrial Area, Jodhpur 342008, Rājasthān, India. ankuranaesthesia@gmail.com
Received: October 17, 2025 Revised: December 13, 2025 Accepted: February 14, 2026 Published online: June 9, 2026 Processing time: 217 Days and 23.6 Hours
Abstract
BACKGROUND
Sepsis is associated with impaired tissue perfusion and elevated serum lactate, a key prognostic marker. Magnesium plays a vital role in cellular energy metabolism and may enhance lactate clearance in sepsis.
AIM
To investigate the impact of magnesium on the clearance of lactate in critically sick patients with sepsis.
METHODS
In this triple-blind, randomized trial, 138 adult patients with a diagnosis of sepsis (according to Sepsis-3 guidelines) and with serum lactate levels > 2 mmol/L were randomized into the magnesium (M) group and the placebo (P) group. Randomization was performed using an online sequence generator. The individuals in group M were administered 2 g of magnesium sulphate infusion diluted in 50 mL of normal saline over 2 hours for 3 days. The individuals in group P were administered an identical volume of normal saline for three days. The primary outcome was to compare the time to lactate clearance (20% decrease from baseline) in both groups. The secondary outcomes included changes in lactate clearance, intensive care unit (ICU) duration, hospital stay, and 28-day mortality in both groups.
RESULTS
Time to 20% lactate clearance was considerably lower in the M group (5.73 ± 2.19 hours) when compared to the P group (8.54 ± 2.72 hours), with a mean difference [95% confidence interval (CI)]: -2.81 (-3.65 to -1.99), P < 0.001. Mean rise in lactate clearance was markedly more significant in M group than P group on day 1 [18.88% ± 1.80% vs 12.61% ± 1.94% respectively, with mean difference (95%CI): 6.26 (5.63-6.89), P < 0.001] on day 2 [30.02% ± 4.30 % vs 23.34% ± 4.76% respectively, with mean difference (95%CI): 6.68 (5.15-8.20), P < 0.001] and day 3 [50.74% ± 6.06 % vs 37.94% ± 4.53% respectively, with mean difference (95%CI): 12.80 (11.00-14.60), P < 0.001]. The length of ICU stay was considerably shorter in the M group, 8 (3-15) days, compared to the P group, 12 (5-19) days (P < 0.001). The duration of hospitalization was significantly decreased in the M group, 12 (4-24) days than in the P group, 16 (9-25) days (P < 0.001); however, the 28-day mortality was similar in both groups.
CONCLUSION
Magnesium supplementation was associated with shorter lactate clearance time and reduced ICU and hospital stay duration in patients with sepsis; however, the difference in 28-day mortality between the groups was statistically nonsignificant.
Core Tip: Early lactate clearance is a key therapeutic target and prognostic marker in sepsis. In this randomized clinical trial, magnesium supplementation significantly accelerated lactate clearance in critically ill patients with sepsis and was associated with reduced vasopressor requirements, shorter intensive care unit stay, and decreased overall hospital stay. Although the magnesium group demonstrated a numerically lower 28-day mortality, this difference did not reach statistical significance.
