Lactic acidosis

Type A: hypoxic (eg, shock, mesenteric ischemia, CO poisoning, cyanide) Type B: nonhypoxic. ↓ clearance (eg, hepatic dysfxn) or ↑ generation [eg, malig, EtOH, thiamine def., meds (metformin, NRTIs, salicylates, propylene glycol, propofol, isoniazid, linezolid)] D-lactic acidosis: short bowel syndrome → precip by glc ingest → metab by colonic bacteria to d-lactate; not detected by standard lactate assay

(NEJM 2014; 371:2309)