The patient does not have to have hypotension to be in septic shock. If the lactate is greater than 4 and meets severe sepsis criteria then they are in septic shock at the time of the lactate being greater than 4. Regarding hypotension, if the patient does not respond to fluids of 30 ml/kg after an hour than that patient is in septic shock. You have to look at the measures separately. Hope this helps.
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