Anion gap acidosis with hypoglycemia in acetaminophen toxicity

Two case reports of patients with anion gap metabolic lactic acidosis and hypoglycemia are presented. Both patients subsequently died of acute liver failure secondary to acetaminophen hepatotoxicity. The development of type B lactic acidosis with hypoglycemia might have been caused by a deficit in gluconeogenesis secondary to severe hepatic failure and/or a toxic metabolite of acetaminophen. Our findings suggest that acetaminophen toxicity should be considered when lactic acidosis and hypoglycemia are seen.