Lactic acidosis and hypoglycemia are frequently seen in the ICU. The etiology is usually obvious. Lactate is the end product of anaerobic glycolysis and is cleared in the liver and kidneys. Lactic acidosis is caused by the accumulation of lactic acid in the blood. This could be due to various factors (Table 1
). The most common mechanism is decreased tissue perfusion from sepsis and cellular shock. Underlying diseases such as diabetes, renal failure, liver disease, alcoholic ketoacidosis, pancreatitis, and seizure can also lead to lactic acidosis. Lactic acidosis can also be due to intoxication with agents such as acetaminophen, biguanides, β-adrenergic agonists, alcohols and glycols, salicylates, isoniazid, valproic acid, cyanide-forming compounds, propofol, and cocaine. Antiretroviral nucleoside analogues have been also associated with lactic acidosis. Other less common factors include the inborn errors of metabolism involving the enzymes of the glycolytic pathway.