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Differential Diagnosis of Lactic Acidosis • Streptozocin • Shock (hypovolemic, cardiogenic, endotoxic) • Severe congestive heart failure (CHF) • Severe anemia • Sepsis • Seizure activity • Salicylates • Respiratory failure (asphyxia) • Nucleoside reverse transcriptase inhibitors (e.g., zidovudine, didanosine, stavudine) • Neoplastic diseases (e.g., leukemia, lymphoma) • Liver or renal failure • Isoniazid • HIV infection • Glucose-6-phosphate dehydrogenase (G6PD) deficiency and others • Fructose or sorbitol • Ethanol, methanol, ethylene glycol • Diabetes mellitus (DM) • Carbon monoxide (CO) or cyanide poisoning • Biguanides (phenformin, metformin [usually occurring in patients with renal insufficiency]) • Alkalosis • Abnormal intestinal flora 
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