What Is Fetor Hepaticus?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 28 July 2019
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Fetor hepaticus is a distinctive breath odor associated with hepatic encephalopathy, a condition resulting from the accumulation of toxins in the blood stream that compromises brain function. The breath of someone with hepatic encephalopathy is often characterized as musty and sometimes referred to as breath of the dead. Associated with late-stage liver disease, treatment for fetor hepaticus and hepatic encephalophathy can range from dietary changes to the use of medications designed to flush the body of toxins. If left untreated, hepatic encephalopathy can be fatal.

The liver is responsible for filtering and neutralizing toxic substances that enter the body. When liver function is compromised due to disease or injury, the filtration process can be disrupted. Toxins that are not neutralized pose a serious risk to blood health and organ function. Prolonged liver impairment can cause a buildup of toxins in the bloodstream placing vital organs, such as the brain, and nervous system at risk for hepatic encephalopathy.

When the liver fails to filter out toxins, such as ammonia, there is no place for the toxins to go but into the blood. Significant toxin accumulation causes hepatic encephalopathy, or compromised brain function. With hepatic encephalopathy, as the tainted blood moves through the lungs the toxins are expelled in breath, creating fetor hepaticus.


Several tests are used to confirm a diagnosis of hepatic encephalopathy. Liver function tests are the primary tool used to measure organ function. Imaging tests are used to evaluate the physical condition of the liver and check for signs of scarring. Blood tests may also be ordered to check potassium levels and for signs indicative of infection and disease.

Individuals with fetor hepaticus demonstrate additional signs and symptoms of hepatic encephalopathy. Abdominal discomfort, impaired speech and delayed motor movements can occur. It is not uncommon for some individuals to experience impaired cognition and confusion. Personality changes and significant lethargy are also signs of hepatic encephalopathy. During its most advanced stages, hepatic encephalopathy can induce a comatose state.

Considered a medical emergency, fetor hepaticus and hepatic encephalopathy requires timely treatment to increase one’s chance for survival. Individuals with this condition are considered in the late stages of hepatic encephalopathy. Treatment is dependent on removing the toxins from one’s blood.

Individuals with fetor hepaticus and hepatic encephalopathy usually have a significantly high concentration of ammonia in their system. Adjusting diet to limit high protein foods can help reduce ammonia levels in the blood. Severe hepatic encephalopathy cases can require a person be fed intravenously as he or she undergoes additional treatment.

Medications designed to inhibit ammonia production within the digestive system are sometimes given. Those exhibiting significant signs of compromised organ function and those at risk for intracranial swelling may be given mechanical support, such as supplemental oxygen. Individuals with acute hepatic encephalopathy possess a good prognosis if treatment is timely and appropriate. If the person has been diagnosed with a chronic liver condition, such as cirrhosis, he or she is at greater risk for recurrent hepatic encephalopathic infection. Irreversible brain damage and death can occur if hepatic encephalopathy is left untreated.


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Post 1
With severe encephalopathy there is a risk of losing important reflex reactions. When a person gets to the later stages of encephalopathy hospitalization may be necessary. The deterioration in the liver leads to the build up of ammonia and other toxins in the body.

Protective reflexes caused by the toxins lead to symptoms like respiratory failure, due to an unnatural relaxation of the gag reflex. It can come to a point where a patient may need to be intubated to prevent aspiration.

Treatment for encephalopathy depends on the underlying issues causing the damage. Alcoholism, hepatitis and fatty liver disease are possible culprits. Even worse, these issues can bring on cirrhosis of the liver, a disease characterized by scarring of the liver, as well as encephalopathy.

The worse case scenario with encephalopathy is when you reach a point where a liver transplant may be necessary. When acute liver failure sets in the mortality rate is greatly raised.

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