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What Is Fetor Hepaticus?

Medically Reviewed by Dan Brennan, MD on May 10, 2021

Fetor hepaticus is a chronic odor in your breath. It’s different from normal bad breath. Usually, your breath is affected by what you eat. You might have an unpleasant odor in the morning.

The scent of fetor hepaticus is more distinct and smells like sulfur. It happens as a result of liver disease.

Learn more about fetor hepaticus and how to manage the condition.

Symptoms of Fetor Hepaticus

Fetor hepaticus is a distinctive breath odor that people with liver disease can have. It is not pleasant. People describe it as smelling like a mixture of rotten eggs and garlic.

But it is not related to hygiene or dental health. You can’t solve fetor hepaticus by brushing your teeth more often or using special mouthwash. Fetor hepaticus is not a condition by itself. It is a symptom of liver problems. 

These distinctive changes to the smell of your breath often alert doctors to liver disease. You should contact a doctor if you have fetor hepaticus. You may need tests to check your liver functions.

Causes of Fetor Hepaticus

The liver is the largest organ in your body. It is responsible for cleaning waste products out of your blood. Your liver acts as a filter and transforms certain substances in your blood into bile. That bile then goes into your intestines. You eventually excrete it in your feces.

Your liver doesn’t filter out all the substances that it is supposed to when it isn’t working properly. 

One of the major effects of liver disease is that the liver may not filter out compounds that contain sulfur. This means they stay in your body and produce your fetor hepaticus. It indicates liver failure because it results from an increase of dimethyl sulfide in the air that you exhale. So liver failure results in this noticeable smell in your breath.

Liver disease is a serious condition that requires medical treatment. It must be treated and won’t go away on its own. You should speak to a doctor about the situation as soon as you can.

What Is Liver Disease?

Liver disease is any condition that reduces the ability of your liver to do its job. Liver disease affects millions of people every year. The causes of liver disease include:

  • Viruses
  • Family history of liver disease
  • Autoimmune disease
  • Excessive use of alcohol
  • Dietary factors
  • Obesity
  • Reactions to medication or chemical exposure

Liver disease ranges from mild to severe. It follows a predictable pattern no matter what its cause is. 

Here are the three typical phases of liver disease.

Hepatitis. Hepatitis is an inflammation of the liver. You may notice symptoms such as fatigue, aches, digestive issues, and the yellowing of your skin and eyes called jaundice. Hepatitis can be reversed if it’s diagnosed early.

‌‌Fibrosis. Fibrosis happens after an extended period of liver inflammation. Your liver starts to develop scar tissue. The scar tissue makes it less efficient at filtering out toxins. Your liver can repair itself and there is treatment available for fibrosis. So the damage at this stage may not be permanent.

‌‌Cirrhosis. Cirrhosis is the name for a severely scarred liver. Its function will be limited and the damage is permanent. Treatment is available to prevent the condition from getting worse. There is no cure.

Another issue you may face is liver cancer. Liver cancer can develop due to advanced liver disease. Your doctor should monitor you for liver cancer if you have liver fibrosis or cirrhosis. Early detection offers more treatment options for liver cancer.

Treatment of Fetor Hepaticus

Reducing the bad breath that comes from fetor hepaticus depends on getting your liver to work better. Your doctor will do a series of tests to see how severe your liver disease is. You may need blood tests or a liver biopsy

Doctors will make recommendations for treatment once they know how much damage there is to your liver. Some liver diseases can be improved with lifestyle changes. Your doctor may suggest that you:

  • Reduce or eliminate alcohol use.
  • Cut back on rich foods such as red meat, trans fats, and processed carbohydrates.
  • Exercise regularly.
  • Eat fewer calories daily to reach a healthier weight.

You may also need medications to help manage the condition. Surgery or even a liver transplant may be the best course of treatment in severe cases. Your doctor will work with you to create the best treatment plan for your needs.

Liver disease is a serious condition. Call your doctor for treatment if you have fetor hepaticus or other symptoms of liver disease.

WebMD Medical Reference

Sources

SOURCES:

American Liver Foundation: “The Progression of Liver Disease.”

JOHNS HOPKINS: “Functions of the liver.”

MAYO CLINIC: "Liver disease.”

National Center for Biotechnology Information: “Fetor hepaticus.”

OWLSTONE MEDICAL: “Breath Analysis of Liver Diseases – The Story So Far.”

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