Lack of clarity over serum lactate test

It remained unclear as the inquest adjourned yesterday when Ms Halappanavar’s lactate levels were first measured and why they had still not been measured by the morning of Wednesday, October 24th, when it was suspected that she had developed sepsis.

The inquest has been told lactate levels were a key indicator of onsetting sepsis, as lactic acid is produced when vital organs are not being adequately supplied with oxygen. It has heard that although bloods were taken from Ms Halappanavar at 6am on the Wednesday and sent to the laboratory with a request that lactate levels be measured, this was not done. Concern was being raised at 6.30am on the Wednesday that Ms Halappanavar was moving towards sepsis.

A request was sent with the blood that it be tested for white cell count, protein levels, kidney and liver function and serum lactate level, the lactate level was not measured.

Following a request for clarification on this from the coroner, Dr Ciarán MacLoughlin, senior counsel for the HSE and Galway University Hospital, Declan Buckley, said yesterday it was hospital policy that the laboratory did not test for serum lactate and policy was that this would be done on the wards.

The sample, having been screened for the other items, was sent back to the ward to be tested at a “point of care” testing centre.

Dr MacLoughlin heard a phone call had been made at 8.49am from the lab to the ward to notify the staff there of two of the blood results, but it was unclear whether there was an instruction from the lab to carry out the test for lactate on the ward.

Later, Dr Paul Naughton, anaesthetist in the intensive care unit, said that by the time Savita came to him, she had had multi-organ failure.