Potential therapeutic benefit of exogenous ketone ester administration in delirium: a narrative review

This narrative review discusses how exogenous ketone esters might help with delirium in critical illness. It describes altered neurometabolism and neuroinflammation as key features and notes that mechanistic data come mostly from murine models, particularly for sepsis-associated encephalopathy. The authors state that data in the critically ill are limited, but pilot studies suggest enteral ketone supplementation can safely achieve therapeutic serum concentrations without worsening acidosis or hemodynamic instability. They hypothesize that ketone esters may support brain energy production and call for randomized controlled trials to verify safety, optimal dosing and clinical effectiveness.