Fetor Hepaticus

Medically reviewed by Judith Marcin, MD on January 9, 2018Written by Nancy Moyer on January 9, 2018

What is fetor hepaticus?

Fetor hepaticus occurs when your breath has a strong, musty smell. It’s a sign that your liver is having trouble doing its job of filtering out toxic substances, usually due to severe liver disease. As a result, sulfur substances end up in your bloodstream and can make their way to your lungs. When you exhale, these substances give your breath a distinct smell.

You might also hear fetor hepaticus referred to as “breath of the dead.” This is due to its association with severe liver disease, which can be fatal.

What are the symptoms of fetor hepaticus?

The main symptom of fetor hepaticus is breath that smells like a combination of rotten eggs and garlic. Other people describe it as a slightly sweet smell.

Additional symptoms include:

  • confusion and disorientation
  • bleeding easily
  • yellow skin
  • swollen legs
  • abdominal swelling

What causes fetor hepaticus?

Fetor hepaticus is associated with severe liver disease, which causes scarring and poor functioning of your liver. This can result in portal hypertension, which refers to increased blood pressure in the veins of your liver. Portal hypertension makes it hard for blood to flow through your liver, so it gets backed up in the veins surrounding your liver.

When blood doesn’t pass easily through your liver, the toxic substances that would usually be filtered out by your liver make their way to other parts of your body, including your lungs. When this happens, you might smell traces of these substances when you exhale. Dimethylsulfide is likely responsible for the distinct smell of fetor hepaticus.

How is fetor hepaticus diagnosed?

If you’ve already been diagnosed with liver disease, such as chronic hepatitis or cirrhosis, your doctor can likely diagnose fetor hepaticus without any additional testing.

If you have symptoms of fetor hepaticus but haven’t been diagnosed with liver disease, your doctor will probably start by asking some questions about your medical history and lifestyle habits. They may also order a blood test to check your liver function.

If your doctor suspects you may have portal hypertension, they may also use an ultrasound or CT scan to get a better look at the veins around your liver and check for portal hypertension.

Your doctor may also perform a liver biopsy. This involves taking a small tissue sample from your liver and looking at it under a microscope. A liver biopsy allows your doctor to check for signs of liver disease or evaluate how well a particular treatment is working.

How is fetor hepaticus treated?

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. While you might not be able to reverse the damage to your liver, beta blockers can help to reduce portal hypertension and slow additional liver damage.

To further slow the progression of liver damage and manage complications, you may also need to make some lifestyle changes, including:

  • avoiding alcohol
  • eating less salt
  • getting regular exercise

Work with your doctor to figure out which treatment options would work best based on the stage of your liver disease and overall health.

Outlook for people with fetor hepaticus

Fetor hepaticus is a sign of advanced liver disease. While it’s likely too late to reverse the damage to your liver, certain medications and lifestyle changes can help to ease the symptoms and slow additional damage. If you have symptoms of fetor hepaticus, try to see your doctor as soon as possible so you can start coming up with a plan to manage your liver disease.

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