What causes the smell of fetor hepaticus?
Dimethyl sulfide and methyl mercaptan are probably the dominant smells in fetor hepaticus. Dimethyl sulfide has a pungent, garlicky smell, while methyl mercaptan smells more like rotten eggs or cabbage. Other possible contributors include ammonia, acetone, trimethylamine and certain ketones.
These substances (volatile organic compounds, or VOC) are natural byproducts of your metabolism. They circulate in your blood and come out in your pee, poop and breath. Usually, they aren’t so highly concentrated that you can smell them. That happens when your body isn’t clearing them well enough.
What conditions lead to fetor hepaticus?
The metabolic waste products that cause fetor hepaticus normally go to your liver for filtering. Blood from your digestive system travels to your liver through your portal vein. Your liver filters your blood and sorts the waste products into bile. The filtered blood then returns to your general circulation.
Fetor hepaticus means this process is failing. Either your liver isn’t filtering your blood effectively, or the blood carrying these waste products isn't going to your liver. In the first case, you have liver failure. In the second case, you have a portosystemic shunt. This means an abnormal connection has formed between your portal vein and other blood vessels in your body, allowing blood to bypass your liver.
Liver failure
Most people who develop fetor hepaticus have chronic liver failure, which is the end stage of chronic liver disease. It’s also known as decompensated cirrhosis. Cirrhosis means permanent scarring of your liver tissues. Decompensated means there’s so much scarring that your liver can’t function anymore.
Sometimes, acute liver failure can also cause fetor hepaticus. This is an urgent but possibly reversible condition. It happens when your liver is so overwhelmed by its immediate toxic load that it temporarily stops functioning. Whether you have acute or chronic liver failure, you should seek urgent care.
Portal hypertension
You might develop a portosystemic shunt that bypasses your liver if you have portal hypertension — high blood pressure in your portal vein. High blood pressure means your portal vein is backed up. Your body compensates for this by diverting the blood flow into other veins that go around the backup.
The most common cause of portal hypertension is, again, cirrhosis. So, most people with fetor hepaticus have both portal hypertension and chronic liver failure. But portal hypertension does have a few other possible causes, including blood clots, chronic heart failure, a liver infection called schistosomiasis and, rarely, liver cancer.
How do I know if I have fetor hepaticus?
Fetor hepaticus is a likely explanation for your bad breath if:
- It fits the description (musty and sweet, or like rotten eggs and garlic).
- It’s chronic (it’s lasted a while and doesn’t go away or keeps coming back).
- You already know (or suspect) that you have liver disease.
If you think you might have fetor hepaticus, check in with a healthcare provider. They might recognize the smell from experience. They’ll also take note of your other symptoms and your overall condition. If you don’t have a diagnosis yet, they’ll need to assess you for liver disease and portal hypertension.
What other symptoms might I have with fetor hepaticus?
Other signs and symptoms of liver failure include:
Other signs and symptoms of portal hypertension include:
FAQs
Fetor hepaticus is a likely explanation for your bad breath if: It fits the description (musty and sweet, or like rotten eggs and garlic). It's chronic (it's lasted a while and doesn't go away or keeps coming back). You already know (or suspect) that you have liver disease.
What stage of liver disease is fetor hepaticus? ›
Fetor hepaticus is a late sign of hepatocellular failure and indicates the onset of hepatic encephalopathy, a condition in which the consciousness is affected along with other motor parameters, by the elevated levels of toxic substances in the brain.
What does fetor hepaticus smell like? ›
Fetor hepaticus is the characteristic breath of patients with severe parenchymal disease, which has been likened to a mixture of rotten eggs and garlic. Gas chromatography reveals that the principal compound causing the odor is dimethylsulfide.
How do you fix fetor hepaticus? ›
Getting rid of fetor hepaticus relies on treating the underlying liver disease. This is often very difficult, since fetor hepaticus usually accompanies advanced liver disease.
Can fatty liver cause fetor hepaticus? ›
One of the peculiar symptoms of the fatty liver disease is having "breath of the dead". Also known as Fetor hepaticus, the breath of the dead is a chronic odour in your breath and can be easily distinguished from your normal breath.
What does poop smell like with liver disease? ›
Stool That Smells Like Ammonia
This gas can also smell like old urine. Your large intestine produces ammonia when it digests protein. Your liver then neutralizes the ammonia and helps the body get rid of it. Ammonia smells from your stool may signal a problem with these organs, such as liver disease.
How long can you live with fetor hepaticus? ›
Fetor hepaticus alone can't determine your prognosis (outlook) because different conditions have different possible outcomes. Having chronic liver failure does limit your life expectancy, but the range can be from months to years.
What does your breath smell like if you have liver problems? ›
Foetor hepaticus is a feature of severe liver disease; a sweet and musty smell both on the breath and in urine. It is caused by the excretion of dimethyl disulphide and methyl mercaptan (CH3SH)2, arising from an excess of methionine.
What is the difference between halitosis and fetor? ›
Halitosis, also known as fetor oris, refers to the symptom of foul oral odor, commonly termed "bad breath".
What disease is associated with feces smelling breath? ›
GERD, or gastroesophageal reflux disease, can cause a person's breath to smell like feces because the stomach acid backs up into the esophagus. This acidic wash irritates the esophagus, which can cause extreme discomfort as well as foul breath.
Lifestyle and home remedies
- Brush your teeth after you eat. Keep a toothbrush at work to use after eating. ...
- Floss at least once a day. ...
- Brush your tongue. ...
- Clean bridges, dentures, retainers and mouth guards. ...
- Keep your mouth moist. ...
- Change your diet. ...
- Replace your toothbrush. ...
- Schedule regular dental checkups.
Rarely, people can have bad breath because of organ failure. A person with kidney failure may have breath that smells like ammonia or urine. Serious liver disease can make breath smell musty or like garlic and rotten eggs. Compounds that are transported through the blood can also be released through your sweat glands.
What does liver failure urine smell like? ›
Liver disease and certain metabolic disorders may cause musty-smelling urine.
What are the symptoms of hepatic encephalopathy fetor hepaticus? ›
Foul-smelling breath associated with liver disease (i.e., fetor hepaticus). Enhanced rate of breathing (i.e., hyperventilation). Elevated concentrations of ammonia in the serum2 after a period of fasting. Reduced awareness or consciousness.
What does liver failure poop look like? ›
If your liver doesn't make bile normally or if the flow from the liver is blocked, your poop will look pale like the color of clay. Pale poop often happens along with yellow skin (jaundice).
Where do you itch with liver problems? ›
A vast majority of patients report a diurnal variation of itch intensity, with the worst itch in the late evening and early night-time. Typically, cholestatic pruritus affects limbs, soles of the feet and palms (palmoplantar pruritus) but generalised itch may also occur.
What does bad gallbladder poop look like? ›
Lighter-colored stool. Diarrhea. Dark or brown-colored urine. Jaundice, or yellow-ish skin or whites of eyes.
What does stage 3 liver disease look like? ›
Stage 3 is cirrhosis of your liver, caused by severe liver scarring. At the cirrhosis stage, you may experience more symptoms of liver damage including jaundice, weakness, fatigue, appetite and weight loss, abdominal bloating, and edema in your extremities.
What are the symptoms of stage 2 liver disease? ›
If cirrhosis gets worse, some of the symptoms and complications include:
- yellowing of the skin and whites of the eyes (jaundice)
- vomiting blood.
- itchy skin.
- dark pee and tarry-looking poo.
- bleeding or bruising easily.
- swollen legs (oedema) or tummy (ascites) from a build-up of fluid.
- loss of sex drive (libido)
Stage 4: Liver failure
Liver failure begins when your liver can no longer function adequately for your body's needs. This is also called “decompensated cirrhosis” — your body can no longer compensate for the losses. As liver functions begin to break down, you'll begin to feel the effects throughout your body.
Symptoms of decompensated cirrhosis might include: Yellow discolouration of the skin (jaundice) Fluid retention with abdominal distension (ascites) Leg swelling (oedema)
