1.The Question
Elevated lactate in sepsis tracks with worse outcomes, and how fast it clears tracks with recovery. Magnesium is a cofactor in the enzymes that run cellular energy metabolism, so the logic is direct: if magnesium is low or borderline, topping it up might help the body clear lactate faster. This trial is the first to specifically test time to 20% lactate clearance as the primary endpoint after magnesium supplementation in sepsis.
2.Trial Design
| Design | Single-center, triple-blind RCT |
| Population | 138 adults meeting Sepsis-3 criteria, serum lactate above 2 mmol/L |
| Intervention | 2 g magnesium sulfate in 50 mL normal saline over 2 hours, daily for 3 days (Group M) |
| Control | Identical-volume saline placebo (Group P) |
| Primary outcome | Time to 20% lactate clearance from baseline |
| Secondary outcomes | 28-day mortality, daily lactate clearance percentage, vasopressor dose, ICU and hospital length of stay |
3.Primary Outcome
Time to 20% lactate clearance: 5.73 ± 2.19 hours with magnesium versus 8.54 ± 2.72 hours with placebo. Mean difference -2.81 hours (95% CI -3.65 to -1.99), P<.001.
Nearly 3 hours faster to hit the same clearance threshold is a real physiologic signal, not a marginal one.
4.Secondary Findings
| Measure | Magnesium | Placebo |
|---|---|---|
| Lactate clearance, day 1 | 18.88% | 12.61% |
| Lactate clearance, day 2 | 30.02% | 23.34% |
| Lactate clearance, day 3 | 50.74% | 37.94% |
| ICU length of stay | 8 days | 12 days |
| Hospital length of stay | 12 days | 16 days |
Vasopressor dose was significantly lower in the magnesium group on days 2 and 3, consistent with magnesium's known effect on vascular tone and microcirculatory perfusion.
5.Mortality: the Honest Gap
28-day mortality was numerically lower in the magnesium group, but the difference did not reach statistical significance. The authors attribute this to the single-center design and modest sample size (138 patients total), not to an absence of effect. This is the same pattern seen in earlier, smaller magnesium trials in sepsis.
A faster physiologic marker moving faster is not the same claim as fewer people dying. Both can be true, but only one of them was actually shown here.
6.How This Compares
Noormandi et al (Eur J Clin Pharmacol, 2020) ran a similar triple-arm comparison in 58 patients with severe sepsis and found the same direction of effect, though the two trials measured "time to clearance" differently, so the raw hour counts are not directly comparable.
| Trial | N | Lactate clearance, day 2 | Lactate clearance, day 3 |
|---|---|---|---|
| Anbarasan et al, 2026 | 138 | 30.02% vs 23.34% | 50.74% vs 37.94% |
| Noormandi et al, 2020 | 58 | 27.53% vs 23.79% | 49.83% vs 37.02% |
Two independent trials, different countries, similar magnitude of effect on the percentage-clearance metric. That consistency is more reassuring than either trial alone.
7.Bottom Line & Sources
Clinical takeaway: in septic patients with an elevated lactate, empiric magnesium supplementation (2 g IV over 2 hours, daily for 3 days) speeds lactate clearance, cuts vasopressor requirements, and shortens ICU and hospital stay in this trial. It has not yet been shown, in an adequately powered trial, to reduce mortality. Treat it as a physiologically plausible adjunct with two consistent positive trials behind it, not as a mortality-proven intervention.
- Anbarasan C, Sharma A, et al. 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. doi:10.5492/wjccm.v15.i2.115389
- Noormandi A, Khalili H, Mohammadi M, Abdollahi A. Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial. Eur J Clin Pharmacol. 2020;76(2):175-184.