Fetor hepaticus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and Keywords: Breath of the dead; foetor hepaticus; hepatic foetor


Fetor hepaticus is a condition seen in portal hypertension where portosystemic shunting allows thiols to pass directly into the lungs. It is a late sign in liver failure and is one of the clinical features of hepatic encephalopathy. Other possible causes are the presence of ammonia and ketones in the breath. The breath has a sweet, fecal smell to it.

The compound dimethyl sulfide has been associated with it,[1] raising the possibility of an objective noninvasive measure of liver failure. Furthermore, the volatile dimethyl sulfide is thought by some researchers to be the main contributor to the odor of fetor hepaticus.[2][3] A secondary form of trimethylaminuria is also associated with liver failure, and it has been suggested that that trimethylamine is also a contributor to the odor of fetor hepaticus.[4]

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  1. Van den Velde S, Nevens F, Van Hee P, van Steenberghe D, Quirynen M (November 2008). "GC-MS analysis of breath odor compounds in liver patients". J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. 875 (2): 344–8. doi:10.1016/j.jchromb.2008.08.031. PMID 18938115.
  2. Kaji, H (May 1, 1978). "Gas chromatographic determination of volatile sulfur compounds in the expired alveolar air in hepatopathic subjects". Journal of chromatography. 145 (3): 464–8. doi:10.1016/s0378-4347(00)81377-8. PMID 659533. Unknown parameter |coauthors= ignored (help)
  3. Tangerman, A (Feb 19, 1994). "Cause and composition of foetor hepaticus". Lancet. 343 (8895): 483. doi:10.1016/s0140-6736(94)92729-4. PMID 7905979. Unknown parameter |coauthors= ignored (help)
  4. Mitchell, S (May 1999). "Trimethylamine and foetor hepaticus". Scandinavian journal of gastroenterology. 34 (5): 524–8. doi:10.1080/003655299750026281. PMID 10423071. Unknown parameter |coauthors= ignored (help)