Type A (tissue hypoperfusion)
Hypovolemia
Cardiac failure
Sepsis
Type B (decreased utilization)
Alcoholism
↓ Lactate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate<unk> 
DKA
Mainly due to D-lactate production, though hypovolemia contributes
Liver disease (decreased clearance)
Adrenergic receptor agonism; viz., albuterol, epinephrine, etc
Malignancy
Carbon Monoxide poisoning
Cyanide poisoning
Type D
episodes of encephalopathy and metabolic<unk>  typically following high carbohydrate meals in patients with short bowel syndrome
metabolic<unk>  and high serum anion gap, normal lactate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
Type D lactate is not detected with standard lactate levels
Hypovolemia
Cardiac failure
Sepsis
Alcoholism
↓ Lactate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate<unk> 
DKA
Mainly due to D-lactate production, though hypovolemia contributes
Liver disease (decreased clearance)
Adrenergic receptor agonism; viz., albuterol, epinephrine, etc
Malignancy
Carbon Monoxide poisoning
Cyanide poisoning
↓ Lactate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate
Mainly due to D-lactate production, though hypovolemia contributes
episodes of encephalopathy and metabolic<unk>  typically following high carbohydrate meals in patients with short bowel syndrome
metabolic<unk>  and high serum anion gap, normal lactate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
Type D lactate is not detected with standard lactate levels
Type D lactate is not detected with standard lactate levels
Any shock state
SIRS; lactate may be 2-5 mEq/L
Thiamine deficiency; more often seen in ICU settings; Thiamine is a co-factor for pyruvate dehydrogenase
Seizure
Dead gut
Hepatic failure
Malignancy
Exercise
Albuterol and other beta agonists
Toxicologic Causes:
Cyanide
Carbon Monoxide<unk> 
Didanosine
Stavudine
Zidovudine
Linezolid
Strychnine
Emtriva
Rotenone (Fish Poison
NaAzide (Lab Workers)
APAP (if Liver Fx)
Phospine (rodenticide)
NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote)
INH (if patient seizes)
Hemlock
Valproate
Hydrogen Sulfide
Nitroprusside (if cyanide toxic)
Ricin & Castor Beans
Propofol
Sympathomimetics (cocaine, methamphetamine)
Jequirty peas (Abrus precatorius)
Prunus Amygdalus plants
Crab tree apple seeds & cassava (yucca)
HAART-induced<unk><unk> 
Cyanide
Carbon Monoxide<unk> 
Didanosine
Stavudine
Zidovudine
Linezolid
Strychnine
Emtriva
Rotenone (Fish Poison
NaAzide (Lab Workers)
APAP (if Liver Fx)
Phospine (rodenticide)
NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote)
INH (if patient seizes)
Hemlock
Valproate
Hydrogen Sulfide
Nitroprusside (if cyanide toxic)
Ricin & Castor Beans
Propofol
Sympathomimetics (cocaine, methamphetamine)
Jequirty peas (Abrus precatorius)
Prunus Amygdalus plants
Crab tree apple seeds & cassava (yucca)
HAART-induced<unk><unk>
Metformin-associated lactic acidosis
Type A 
Starvation ketoacidosis
Hypovolemia
Nonketotic hyperglycemia
Cardiac failure
Diabetic ketoacidosis
Sepsis