“…Mechanisms to account for hyperlactatemia from specific drug overdoses are myriad and include the following: hypoperfusion because of vasoconstriction (e.g., ergots) 23 or hypotension (e.g., beta blockers); 24 muscle activity because of seizures (e.g., cocaine) 25 or myoclonus (e.g., serotonin syndrome); 26 altered metabolism of lactate because of increased production (e.g., propylene glycol) 27 or decreased clearance (e.g., metformin); 28 duration of unconsciousness; 5 mitochondrial DNA changes (e.g., nucleoside inhibitors); 29 and failure of cellular respiration because of poisoning of glycolysis (e.g., arsenic), 30 the Kreb’s cycle (e.g., monofluoroacetate), 31 electron transport (e.g., carbon monoxide), 32 or uncoupling of oxidative phosphorylation (e.g., salicylism). 33 …”