• Metformin use
    • You need insulin for Kreb cycle
  • Thiamine B1 Deficiency 2/2 Chronic alcohol intake
    • You need Thiamine for pyruvate dehydrogenase complex
    • Can cause metabolic acidosis
  • Mitochondrial abnormality (e.g. !Cyanide )
  • Recent !Seizure
  • Salbutamol (Ventolin®) puffs every 20 minutes