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OP successfully prevents increases in arterial ammonia while evidence exists from animal models suggesting a significant decrease in extracellular brain ammonia, preventing intracranial hypertension and improving the mental state (mechanism of action summarized in Fig

Although (R)-1,3-butanediol may cause euphoria, dizziness, and gastrointestinal reactions (Shaw et al., 2019), these adverse effects are not common (Stubbs et al., 2019)

J Bioenerg Biomembr 48:591598 Demarest TG, Schuh RA, Waddell J, McKenna MC, Fiskum G (2016) Sex-dependent mitochondrial respiratory impairment and oxidative stress in a rat model of neonatal hypoxic-ischemic encephalopathy