In the present study, deterioration of the patients' conditions, especially hemodynamic failure, was dramatic up to Hours after admission 24 hours after admission. The most effective treatment for metabolic acidosis with high levels of serum lactate is the adequate and timely treatment of fluid resuscitation and vasopressor [20, 21] . All patients needed large amounts of fluids and/or norepinephrine infusion. The median rate of fluid administration needed was 61 ml/kg for 24 hours with the infusion of norepinephrine. However, neither metabolic acidosis nor abnormal serum lactate improved in this study.