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At standard doses, ketone monoester (R-3-hydroxybutyl R-3-hydroxybutyrate) causes a transient decrease in serum pH and bicarbonate, acid-base shifts have not been reported with butanediol (R-1,3-butanediol), and ketone salts are mildly alkalinizing due to the inorganic cations it is delivered with, representing a salt load between 3 and 6 g [111, 116,117,118]

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