Q: All of the following can cause Type B lactic acidosis except

A) Diabetes mellitus 
B)  Malignancy 
C)  Alcoholism
D)  HIV infection
E)  Short bowel syndrome


Answer:  E

In contrast to type A lactic acidosis, where hypoperfusion is the major cause of lactic acidosis, type B lactic acidosis is mostly due to direct impairment of cellular metabolism.

Short bowel syndrome or other forms of gastrointestinal malabsorption causes type D-lactic acidosis. Large amounts of glucose and starch metabolized  by intestinal bacteria produce D-lactic acid. As humans metabolize D-lactic acid slowly, systemic absorption of the D-isomer of lactic acid leads to high plasma D-lactate and consequently metabolic acidosis.

There is no such thing as type C lactic acidosis.

Bonus pearl: D-lactate levels are not measured by most laboratories so specific orders are needed to run Quantitation of D-lactate level.