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Metabolic shock is defined as dysfunction of cellular metabolism, which generally occurs in the face of adequate perfusion and oxygenation. Examples include severe pH derangements, hypoglycemia, adrenal insufficiency, and certain toxicities such as cyanide. The clinical signs seen with metabolic shock closely resemble those in hypovolemic shock and are related to the underlying etiology. Mental depression is the most universally recognized sign of metabolic shock. The same diagnostics used for patients in hypovolemic shock are indicated for the patient in metabolic shock. Treatment may include correction of acid–base derangements with IV fluids and/or bicarbonate, dextrose supplementation, and steroid administration, if adrenal dysfunction is demonstrated or highly suspected [70–74].