beta-Hydroxybutyrate is an alternative substrate for the fetal sheep brain.

Brain uptake of substrates other than glucose has been demonstrated in vivo in postnatal but not fetal life. In this study, brain uptake of potential alternative substrates beta-hydroxybutyrate and lactate was studied during 2 h substrate infusions in 10 chronically-catheterised fetal sheep at 135-141 days gestation. beta-hydroxybutyrate appeared to be taken up by the brain of 5 fetuses with spontaneously low arterial blood glucose concentrations, and produced by the brains of the 5 with higher glucose concentrations. Brain butyrate/oxygen quotients at the end of the infusions were directly related to fetal arterial blood glucose concentrations (r2 = 0.72, P less than 0.01. Brain butyrate/oxygen quotients were not related to the arterial beta-hydroxybutyrate concentrations at the beginning or end of the infusions. No brain uptake of lactate was demonstrated. This study suggests for the first time that the fetal brain in vivo may take up substrates other than glucose. The near term fetal sheep brain appears to take up beta-hydroxybutyrate only when arterial butyrate concentrations are high and glucose is low.