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Lactic acidosis is a common cause of metabolic acidosis with high anion gap and is a potentially lethal complication of a number of diseases. It develops as a result of an imbalance between lactate production and utilization. Malignancies are a relatively uncommon cause between lactate production and utilization. Malignancies are a relatively uncommon cause. 1-8 An 84 year old woman was admitted because of dizziness. She appeared cachetic and her blood pressure was 100/50mmHg without orthosis. A chest X-ray showed a left hilar mass with bilateral mass lesions in the lower lung fields bilaterally shown on needle biopsy to be poorly differentiated squamous cell carcinoma. Liver function tests were normal. Serum sodium was 132mmol/l, chloride 91 mmol/l, potassium 4.8 mmol/l and the total bicarbonate, 16mmol/l and serum creatinine, 1.1 mg/dl. Arterial Pco2 was 24.5 mmHg and the pH was 7.39. A …