endocrine and metabolic disorders
Lactic Acidosis
Type B lactic acidosis
Type B lactic acidosis occurs in states of normal global tissue perfusion (and hence ATP production) and is less ominous. Causes include local tissue hypoxia (eg, as with vigorous muscle use during exertion, seizures, hypothermic shivering), certain systemic and congenital conditions, cancer, and ingestion of certain medications or toxins (see table). Medications include the nucleoside reverse transcriptase inhibitors and the biguanidesmetforminandphenformin(althoughphenforminis no longer available). Metabolism may be decreased due to hepatic insufficiency or thiamin deficiency. 