The several different causes of<unk>  include: * Genetic conditions * Biotinidase deficiency, multiple carboxylase deficiency, or nongenetic deficiencies of biotin * Diabetes mellitus and deafness * Fructose 1,6-bisphosphatase deficiency * Glucose-6-phosphatase deficiency * GRACILE syndrome * Mitochondrial encephalomyopathy,<unk> , and stroke-like episodes * Pyruvate dehydrogenase deficiency * Pyruvate carboxylase deficiency * Leigh syndrome * Drugs *Linezolid * Paracetamol/acetaminophen poisoning *Metformin: this risk is low (less than 10 cases for 100,000 patient years), but the risk of metformin-induced<unk>  (MALA) increases in certain situations where both the plasma levels of metformin are increased and<unk> ctate clearance is impaired. The older related and now withdrawn drug phenformin carried a much higher risk of<unk> . *Isoniazid toxicity *Propofol *Epinephrine *Propylene glycol (D-lactic<unk>  *Nucleoside reverse-transcriptase inhibitors *Abacavir/dolutegravir/lamivudine *Emtricitabine/tenofovir *Potassium cyanide (cyanide poisoning) *Fialuridine * Other * Thiamine deficiency (especially during TPN) * Impaired delivery of oxygen to cells in the tissues (e.g., from impaired blood flow (hypoperfusion)) * Bleeding * Polymyositis * Ethanol toxicity * Sepsis * Shock * Advanced liver disease * Diabetic ketoacidosis * Excessive exercise (overtraining) * Regional hypoperfusion (e.g., bowel ischemia or marked cellulitis) * Cancers such as Non-Hodgkin's and Burkitt lymphomas * Pheochromocytoma * Tumor lysis syndrome * D-lactic<unk>  due to intestinal bacterial flora production in short gut syndrome
Lactic acidosis
Metabolic acidosis
Acidosis
Metabolic alkalosis
Azotemia
Hyperammonemia
Alkalosis
Hypercapnia