Fetor hepaticus, also called ‘breath of the dead’, is a liver disease in which the breath of the patient is sweetish, musty, and sometimes fecal in nature. 

It’s a sign that your liver is having trouble filtering out toxic substances, usually due to severe liver disease. As a result, sulfur substances end up in your bloodstream and make their way to your lungs. When you breathe out, these substances give your breath a distinct smell.

Fetor Hepaticus: What Is The ‘Breath of the Dead’? Can It Be Treated? 

What is Fetor hepaticus?

Fetor hepaticus is an advanced sign of hepatocellular failure. This points to the start of hepatic encephalopathy, a condition in which the patient’s consciousness is affected in addition to other motor parameters by the elevated levels of toxic substances in the brain.

Other conditions associated with fetor hepaticus include diabetic ketoacidosis, and isopropyl alcohol poisoning.

What causes fetor hepaticus?

Fetor hepaticus is a 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 complicates the blood to flow through your liver, making it hard to get 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. Dimethyl Sulfide is likely responsible for the distinct smell of fetor hepaticus.

Other than dimethyl sulfide, causes include substances such as  acetone, 2-butanone and 2-pentanone, all of which are found in higher concentrations in the blood of liver disease patients. Some research indicates that dimethyl sulfide being the primary odor-producing component in the breath of fetor hepaticus. It is thought that testing for dimethyl sulphide may help to evaluate and predict the possibility of hepatocellular failure.

Trimethylamine is also increased in many patients with cirrhosis, and may contribute to the odor of the breath. Another component may be ammonia.

How is fetor hepaticus diagnosed?

For those who fear they have fetor hepaticus know that 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. The process involves taking a small tissue sample from your liver and looking at it under a microscope. This will allow your doctor to check for signs of liver disease very closely and even evaluate how well a particular treatment is working. 

How is fetor hepaticus treated?

Getting rid of fetor hepaticus means treating the underlying liver disease. This is often very difficult, since fetor hepaticus usually is a form of 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

It’s always best to visit your doctor and figure out which treatment options would work well depending on the stage of your liver disease and overall health. Although it’s more or less too late to reverse the damage to your liver, certain medications and lifestyle changes can help to ease the symptoms and slow additional damage.