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In addition, glutathione, reduced as a result of interaction with a large number of oxidized organic metabolites, forms less toxic conjugated compounds, which are subsequently more easily metabolized and excreted as part of mercapturic acids

10.1007/s12013-021-00967-0 86 PengL

This selfish behavior further depletes available energy substrates in peripheral tissues (such as muscle) and the central nervous system (such as the brain), thereby potentially accounting for the systemic exhaustion observed in PEM patients following even minimal exertion (189)

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Clinical features include subacute encephalopathy (confusion, drowsiness, altered level of consciousness), ataxia, and seizures