In brain-injured patients, glucose utilization is suppressed, and lactate can become the dominant fuel source, potentially suppressing BHB uptake.

“and then in an in an now let's talk about the injured brain so now you have a a TBI patient and you're doing the exact same thing you're infusing equal concentrations of of glucose lactate and and BHB what would you think we've already you you know everybody knows clinically that glucose is going to be suppressed how much of that is made up for by the lactate versus the BHB yeah so if lactates around it's going to suppress the BHB so lactate could be the dominant fuel in the injured brain”