Figure 2.

The basic metabolism of beta hydroxybutyrate compared to glucose. KBs arise from liver fatty acid metabolism occurring primarily in the hepatic mitochondrial matrix. Then, they are captured from circulation by extrahepatic tissues and used as an energy source. βHB is oxidized by βHB dehydrogenase to produce AcAc, which takes up CoA from succinyl-CoA to produce acetoacetyl-CoA. Acetoacetyl-CoA then reacts with CoA to produce two molecules of acetyl-CoA, a key intermediate for the citric acid cycle (reviewed in [16,37,43]).