Type A (tissue hypoperfusion)
Hypovolemia
Cardiac failure
Sepsis
Type B (decreased utilization)
Alcoholism
↓<unk> ctate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to<unk> ctate
Metformin
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<unk> ctate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
Type D<unk> ctate is not detected with standard<unk> ctate levels
Hypovolemia
Cardiac failure
Sepsis
Alcoholism
↓<unk> ctate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to<unk> ctate
Metformin
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
↓<unk> ctate utilization secondary to hepatic dysfunction
↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to<unk> ctate
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<unk> ctate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
Type D<unk> ctate is not detected with standard<unk> ctate levels
Type D<unk> ctate is not detected with standard<unk> ctate levels
Any shock state
SIRS;<unk> ctate 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
Metformin
Didanosine
Stavudine
Zidovudine
Linezolid
Strychnine
Emtriva
Rotenone (Fish Poison
NaAzide <unk> b 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> 
Cyanide
Carbon Monoxide
Metformin
Didanosine
Stavudine
Zidovudine
Linezolid
Strychnine
Emtriva
Rotenone (Fish Poison
NaAzide <unk> b 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>
Lactic acidosis
Type A 
Metabolic acidosis
Hypovolemia
Metabolic alkalosis
Cardiac failure
Ketonemia
Sepsis