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Diseases » Halitosis » Causes

Causes of Halitosis



Contents

List of causes of Halitosis

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Halitosis) that could possibly cause Halitosis includes:

More causes: see full list of causes for Halitosis

Causes of Halitosis (Diseases Database):

The follow list shows some of the possible medical causes of Halitosis that are listed by the Diseases Database:

Source: Diseases Database

Halitosis as a symptom:

Conditions listing Halitosis as a symptom may also be potential underlying causes of Halitosis. Our database lists the following as having Halitosis as a symptom of that condition:

Medications or substances causing Halitosis:

The following drugs, medications, substances or toxins are some of the possible causes of Halitosis as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 6 medications causing Halitosis


Medical news summaries relating to Halitosis:

The following medical news items are relevant to causes of Halitosis:

Related information on causes of Halitosis:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Halitosis may be found in:

Causes of Halitosis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Halitosis.

Halitosis: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Head and neck etiologies
    –Foods (e.g., onion, garlic)
    –Dental conditions (periodontal disease, gingivitis, denture odor, dental abscesses, food particles not cleaned from teeth)
    –Postnasal drip
    –Dry mouth (xerostomia): Mouth breathing, side effect of medications, salivary gland disease, dehydration
    –Nasal foreign body
    –Gastroesophageal reflux disease
    –Chronic sinusitis
    –Allergic rhinitis
    –Tonsillar disease (e.g., streptococcal pharyngitis)
    –Zenker's (pharyngoesophageal) diverticulum: Presents as dysphagia, regurgitation, cough, and extreme halitosis
    –Tobacco or alcohol use
  • Systemic etiologies
    –Diabetes mellitus, especially with ketoacidosis
    –Uremia
    –Pulmonary disorders (e.g., bronchiectasis, pneumonia, neoplasms, tuberculosis)
    –Trimethylaminuria (fishy breath odor)
    –Liver failure (fetor hepaticus)
    –Menstruation may exacerbate halitosis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Breath Sounds (Decreased): Differential Diagnosis
(In a Page: Signs and Symptoms)

Decreased airflow through respiratory tree

  • Airway obstruction
    –Aspirated foreign body
    –Asthma
    –Bronchitis
    –Bronchiolitis
    –Croup
    –Epiglottitis
    –Neoplasm
    –Goiter
  • Alveolar or interstitial processes
    –Pulmonary edema
    –Pneumonia
    –Pleurisy
    –Sarcoidosis
  • Decreased lung expansion
    –Atelectasis
    –COPD or emphysema
    –Bronchiectasis
    –Kyphosis or scoliosis
    –Increased abdominal girth (e.g., ascites, obesity, pregnancy)
    –Pulmonary fibrosis
    –Diaphragmatic paralysis
    –Abdominal, chest wall, or pleuritic pain
    Obstructed transmission of sound
    • Obesity
    • Pleural effusion
    • Pneumothorax, hemothorax, or chylothorax
    • Pleural thickening
    • Large pulmonary embolus
    • Less common etiologies (“zebras”) include cystic fibrosis, alveolar hemorrhage, BOOP, now called COP, pneumonectomy (postsurgical), systemic lupus erythematosus, vocal cord paralysis, vocal cord dyskinesia, and psychogenic

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Halitosis: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Upper respiratory
    –Stomatitis: Painful ulcerated lesions on oral mucosa and gingiva; coxsackie virus is commonly called hand-foot-and-mouth disease; herpangina refers to herpetic lesions on the soft palate and posterior pharynx; trench mouth refers to necrotizing gingivostomatitis with pseudomembrane caused by spirochetes or fusiform bacteria
    –Sinusitis: Acute or chronic; pathogens are Streptococcus pneumoniae, β-hemolytic strep, Haemophilus influenzae, and Moraxella catarrhalis; maxillary sinuses are most frequently involved
    –Pharyngitis/tonsillitis/tonsillar abscess: Group A strep
  • Pulmonary disorders
    –Pulmonary abscess
    –Bronchiectasis
  • Gastric disorders
    –GERD
    –Bezoar
  • Dental etiologies
    –Poor oral hygiene: Bacterial accumulation on the teeth or tongue; gingival inflammation; food concretions within tonsillar crypts
    –Dental abscess: May be sequela of baby-bottle tooth decay, untreated dental caries, dental fracture, or poor hygiene
    –Orthodontic devices
  • Chronic mouth breathing
    –Seen in children with nasal polyps, adenoid hypertrophy, allergic rhinitis, and chronic sinusitis
    –Rarely due to a nasopharyngeal tumor such as a hemangioma or fibromas
    –Resultant dryness causes alteration of the oral mucosa and resultant bad breath; taste and smell may be affected
  • Nasal foreign body
    –Seen most often in the toddler/preschool age group
    –History of foreign body placement is not always forthcoming
    –Usually accompanied by unilateral nasal discharge

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Breath with fecal odor: Medical causes

(Handbook of Signs & Symptoms (Third Edition))

❑ Distal small-bowel obstruction. With late obstruction, nausea is present although vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resultant fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, and hyperactive bowel sounds and borborygmi. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.

❑ Gastrojejunocolic fistula. With gastrojejunocolic fistula, symptoms may be variable and intermittent because of temporary plugging of the fistula. Fecal vomiting with resulting fecal breath odor may occur, but the most common chief complaint is diarrhea, accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention and, possibly, marked malabsorption.

❑ Large-bowel obstruction. Vomiting is usually absent initially, but fecal vomiting with resultant fecal breath odor occurs as a late sign. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common with partial obstruction.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Breath with fruity odor: Medical causes

(Handbook of Signs & Symptoms (Third Edition))

❑ Anorexia nervosa. Severe weight loss associated with anorexia nervosa may produce fruity breath, usually with nausea, constipation, and cold intolerance as well as dental enamel erosion and scars or calluses in the dorsum of the hand, both related to induced vomiting.

❑ Ketoacidosis. Fruity breath odor accompanies alcoholic ketoacidosis, which is usually seen in poorly nourished alcoholics with vomiting, abdominal pain, and only minimal food intake over several days. Kussmaul's respirations begin abruptly and accompany dehydration, abdominal pain and distention, and absent bowel sounds. Blood glucose levels are normal or slightly decreased.

With diabetic ketoacidosis, fruity breath odor commonly occurs as ketoacidosis develops over 1 to 2 days. Other findings include polydipsia, polyuria, nocturia, a weak and rapid pulse, hunger, weight loss, weakness, fatigue, nausea, vomiting, and abdominal pain. Eventually, Kussmaul's respirations, orthostatic hypotension, dehydration, tachycardia, confusion, and stupor occur. Signs and symptoms may lead to coma.

Starvation ketoacidosis is a potentially life-threatening disorder that has a gradual onset. Besides fruity breath odor, typical findings include signs of cachexia and dehydration, a decreased LOC, bradycardia, and a history of severely limited food intake (anorexia nervosa).

Other causes

❑ Drugs. Any drug known to cause metabolic acidosis, such as nitroprusside and salicylates, can result in fruity breath odor.

❑ Low-carbohydrate diets. These diets, which encourage little or no carbohydrate intake, may cause ketoacidosis and the resulting fruity breath odor.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Breath with ammonia odor [Uremic fetor]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ End-stage chronic renal failure. Ammonia breath odor is a late finding. Accompanying signs and symptoms include anuria, skin pigmentation changes and excoriation, brown arcs under the nail margins, tissue wasting, Kussmaul's respirations, neuropathy, lethargy, somnolence, confusion, disorientation, behavior changes with irritability, and mood lability. Later neurologic signs that signal impending uremic coma include muscle twitching and fasciculation, asterixis, paresthesia, and footdrop. Cardiovascular findings include hypertension, myocardial infarction, signs of heart failure, pericarditis, and even sudden death and stroke. GI findings include anorexia, nausea, heartburn, vomiting, constipation, hiccups, and a metallic taste, with oral signs and symptoms, such as stomatitis, gum ulceration and bleeding, and a coated tongue. The patient has an increased risk of peptic ulceration and acute pancreatitis. Weight loss is common; uremic frost, pruritus, and signs of hormonal changes, such as impotence or amenorrhea, also appear.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Fetor hepaticus: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Hepatic encephalopathy

Fetor hepaticus usually occurs in the final, comatose stage of this disorder, but may occur earlier. Tremors progress to asterixis in the impending stage; lethargy, aberrant behavior, and apraxia also occur. Hyperventilation and stupor mark the stuporous stage, during which the patient acts agitated when aroused. Seizures and coma herald the final stage, along with decreased pulse and respiratory rates, a positive Babinski’s sign, hyperactive reflexes, decerebrate posture, and opisthotonos

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Breath with fecal odor: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Gastrojejunocolic fistula

Symptoms of gastrojejunocolic fistula may be variable and intermittent because of temporary plugging of the fistula. They may include fecal vomiting with resulting fecal breath odor, but the chief complaint is usually diarrhea accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention, and possibly marked malabsorption.

Large-bowel obstruction

Vomiting is usually absent at first, but fecal vomiting with resulting fecal breath odor occurs as a late sign. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after a complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common in a partial obstruction.

Small-bowel obstruction, distal

In late obstruction, nausea is present but vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resulting fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, hyperactive bowel sounds, and borborygmus. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Breath with fruity odor: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anorexia nervosa

Severe weight loss associated with anorexia nervosa may produce fruity breath odor, usually with nausea, constipation, and cold intolerance. Induced vomiting may cause dental enamel erosion and scars or calluses in the dorsum of the hand.

Ketoacidosis

Fruity breath odor accompanies alcoholic ketoacidosis, which is usually seen in poorly nourished alcoholics with a history of vomiting, abdominal pain, and only minimal food intake over several days. Kussmaul’s respirations begin abruptly and accompany dehydration, abdominal pain and distention, and absent bowel sounds. Blood glucose levels are normal or slightly decreased.

In diabetic ketoacidosis, fruity breath odor commonly acompanies the development of ketoacidosis over 1 to 2 days. Other findings include polydipsia, polyuria, nocturia, weak and rapid pulse, hunger, weight loss, weakness, fatigue, nausea, vomiting, and abdominal pain. Eventually, Kussmaul’s respirations, orthostatic hypotension, dehydration, tachycardia, confusion, and stupor occur. Signs and symptoms may lead to coma.

Starvation ketoacidosis is a potentially life-threatening disorder that has a gradual onset. Besides fruity breath odor, typical findings include signs of cachexia and dehydration, decreased LOC, bradycardia, and a history of anorexia nervosa.

Other causes

Drugs

Any drug known to cause metabolic acidosis, such as nitroprusside and salicylates, can result in fruity breath odor.

Low-carbohydrate diets

Diets that promote little or no carbohydrate intake may cause ketoacidosis and the resulting fruity breath odor.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Halitosis: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Bowel obstruction

Halitosis is a late sign in both small- and large-bowel obstructions, resulting from vomiting of bilious and later fecal material. Other findings in a small-bowel obstruction include constipation, abdominal distention, and intermittent periumbilical cramping pain. In a large-bowel obstruction, abdominal pain is milder and more constant than that associated with a small-bowel obstruction and is usually located lower in the abdomen.

Bronchiectasis

Bronchiectasis usually produces foul or putrid halitosis, but some patients may have a sickeningly sweet breath odor. The patient typically also has a chronic productive cough with copious, foul-smelling, mucopurulent sputum. The cough is aggravated by lying down and is most productive in the morning. Associated findings commonly include exertional dyspnea, fatigue, malaise, weakness, and weight loss. Auscultation reveals coarse or moist crackles over the affected lung areas during inspiration. Digital clubbing is a late sign.

Common cold

A musty breath odor may accompany a common cold, which usually also causes a dry, hacking cough with sore throat, sneezing, nasal congestion, rhinorrhea, headache, malaise, fatigue, arthralgia, and myalgia.

Esophageal cancer

In esophageal cancer, halitosis may accompany classic findings of dysphagia, hoarseness, chest pain, and weight loss. Nocturnal regurgitation and cachexia are late signs.

Gastric cancer

Halitosis is a late sign in gastric cancer. Accompanying findings include chronic dyspepsia unrelieved by antacids, a vague feeling of fullness, nausea, anorexia, fatigue, pallor, weakness, altered bowel habits, weight loss, and muscle wasting. Hematemesis and melena are signs of associated gastric bleeding.

Gastrocolic fistula

In this disorder, fecal vomiting is responsible for fecal breath odor, which is typically preceded by intermittent diarrhea.

Gingivitis

Characterized by red, edematous gums, gingivitis may also cause halitosis. The gingivae between the teeth become bulbous and bleed easily with slight trauma.

Acute necrotizing ulcerative gingivitis also causes fetid breath, a bad taste in the mouth, and ulcers—especially between the teeth—that may become covered with a gray exudate. Severe ulceration may occur with fever, cervical adenopathy, headache, and malaise.

Hepatic encephalopathy

A characteristic late sign of hepatic encephalopathy is fetor hepaticus, a musty, sweet, or mousy (new-mown hay) breath odor. Other late effects include coma, asterixis (flapping tremor), and hyperactive deep tendon reflexes.

Ketoacidosis

Alcohol-induced, diabetic, and starvation forms of ketoacidosis produce a fruity breath odor. Alcohol-induced ketoacidosis is usually seen in poorly nourished alcoholics who have eaten very little over several days. Symptoms include sudden Kussmaul’s respirations with vomiting for several days, light dehydration, abdominal pain and distention, and absent bowel sounds. The patient is alert and has a normal or slightly decreased blood glucose level.

Life-threatening diabetic ketoacidosis produces a rapid, thready pulse; marked hypovolemia; nausea and vomiting; and, in its early stages, the triad of polydipsia, polyphagia, and polyuria.

Also life-threatening, starvation ketoacidosis produces Kussmaul’s respirations; weight loss; bradycardia; dry, scaly skin; sore tongue; muscle and tissue wasting; abdominal distention; and signs of dehydration, such as oliguria and poor skin turgor.

Other common effects of diabetic and starvation ketoacidosis include orthostatic hypotension, generalized weakness, anorexia, abdominal pain, and altered level of consciousness.

Lung abscess

Lung abscess typically causes putrid halitosis, but its cardinal sign is a productive cough with copious, purulent, often bloody sputum. Other findings include fever with chills, dyspnea, headache, anorexia, weight loss, malaise, pleuritic chest pain, asymmetrical chest movement, and temporary clubbing.

Necrotizing ulcerative mucositis (acute)

A strong, putrid breath odor is characteristic of this uncommon disorder, which initially causes slight cheek inflammation that’s rapidly followed by tooth loss and extensive bone sloughing in the mandible or maxilla.

Ozena

This severe, chronic form of rhinitis causes a musty or fetid breath odor as well as thick green mucus and progressive anosmia.

Periodontal disease

Periodontal disease causes halitosis and an unpleasant taste. Typically, the patient’s gums bleed spontaneously or with slight trauma and are marked by pus-filled pockets around the teeth. Related findings include facial pain, headache, and loose teeth covered by calculi and plaque.

Pharyngitis (gangrenous)

Halitosis is a chief sign of gangrenous pharyngitis. The patient also complains of a foul taste in the mouth, an extremely sore throat, and a choking sensation. Examination reveals a swollen, red, ulcerated pharynx, possibly with a grayish membrane. Fever and cervical lymphadenopathy are also common.

Renal failure (chronic)

Renal failure produces a urinous or ammonia breath odor. Among its widespread effects are anemia, emotional lability, lethargy, irritability, decreased mental acuity, coarse muscular twitching, peripheral neuropathies, muscle wasting, anorexia, signs of GI bleeding, ecchymosis, yellow-brown or bronze skin, pruritus, anuria, and increased blood pressure.

Sinusitis

Acute sinusitis causes a purulent nasal discharge that leads to halitosis. Besides a characteristic postnasal drip, the patient may exhibit nasal congestion, sore throat, cough, malaise, headache, facial pain and tenderness, and fever.

Chronic sinusitis causes a continuous mucopurulent discharge that leads to a musty breath odor, postnasal drip, nasal congestion, and a chronic nonproductive cough.

Zenker’s diverticulum

This esophageal disorder causes halitosis and a bad taste in the mouth associated with regurgitation. The patient may also report a chronic cough that’s most pronounced at night, hoarseness, odynophagia, neck pain, and “gurgling” sounds in the throat when he swallows liquids.

Other causes

Drugs

Drugs that can cause halitosis include triamterene, inhaled anesthetics, and any drugs known to cause metabolic acidosis such as nitroprusside.

Herb Alert

Some herbal medicines, such as garlic, may cause halitosis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Breath with ammonia odor [Uremic fetor]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

End-stage chronic renal failure

Ammonia breath odor is a late finding in end-stage chronic renal failure. Accompanying signs and symptoms include anuria, skin pigmentation changes and excoriation, brown arcs under the nail margins, tissue wasting, Kussmaul’s respirations, neuropathy, lethargy, somnolence, confusion, disorientation, behavior changes, irritability, and emotional lability. Later neurologic signs that signal impending uremic coma include muscle twitching and fasciculations, asterixis, paresthesia, and footdrop. Cardiovascular findings include hypertension, myocardial infarction, signs of heart failure, pericarditis, and even sudden death and stroke. GI findings include anorexia, weight loss, nausea, heartburn, vomiting, constipation, hiccups, and a metallic taste. Oral signs and symptoms may include stomatitis, gum ulceration and bleeding, and a coated tongue. The patient has an increased risk of peptic ulceration and acute pancreatitis. Uremic frost, pruritus, and signs of hormonal changes, such as impotence or amenorrhea, may also appear.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Fetor hepaticus: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Hepatic encephalopathy

Fetor hepaticus usually occurs in the final, comatose stage of this disorder but it may occur earlier. Tremors progress to asterixis in the impending stage, which is also marked by lethargy, aberrant behavior, and apraxia. Hyperventilation and stupor mark the stuporous stage, during which the patient acts agitated when aroused. Seizures and coma herald the final stage, along with decreased pulse and respiratory rates, positive Babinski’s reflex, hyperactive reflexes, decerebrate posture, and opisthotonos.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Patterned Breathing: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Tachypnea

❑ Paroxysmal nocturnal dyspnea

❑ Sleep apnea

❑ Cheyne-Stokes

❑ Kussmaul

❑ Biot

❑ Apneustic

❑ Ataxic

❑ Stertorous

Clinical Findings

Tachypnea  Although there are many pulmonary causes, the most important is pulmonary embolism, associated with leg swelling and pleuritic chest pain. Intense tachypnea is also seen with intracranial hemorrhage and metabolic acidosis due to sepsis or salicylate toxicity (Kussmaul, see below).

Paroxysmal nocturnal dyspnea  A patient with congestive heart failure reports awakening from sleep with air hunger and diaphoresis, and opens a window for fresh air. Cough often occurs during an episode.

Sleep apnea  Roommates note loud snoring with periods of apnea terminated by a gasping snore. Excessive daytime somnolence helps to differentiate sleep apnea from regular snoring. The patient is usually obese.

Cheyne-Stokes  Respiration periodically and sequentially increases in depth, then is followed by a 15 to 60 second period of apnea. This pattern is seen most commonly in severe congestive heart failure, but also in meningitis, brain tumor, pneumonia, hypoxia, altitude sickness, and stroke. Delayed feedback to central respiratory centers leads to loss of fine-tuning to changes in pCO2. The circulation time from the lung to the CNS equals one-half the cycle length. A low pontine or upper medullary lesion will produce a Cheyne-Stokes pattern unresponsive to pCO2. These patients will be cyanotic and have CO2 retention. Oxygen will enhance this pattern whereas in classic Cheyne-Stokes, the pattern would be suppressed.

Kussmaul  It occurs as regular, deep, fast breathing without dyspnea in acute metabolic acidosis such as ketoacidosis, salicylate or methyl alcohol toxicity, or uremia. The respirations cannot be interrupted for speech so the patient must pause to breathe. This finding is of value in the differentiation of hypotensive shock, in which tachypnea favors sepsis rather than hypovolemia.

Biot  Irregularly irregular breathing abruptly starts and stops with longer periods of apnea than breathing. Seen in pontine lesions, Biot may precede respiratory arrest.

Apneustic  Bradypnea, in which the breath is held at end-inspiration, is most often a sign of pontine hemorrhage, but it may also occur in basilar artery occlusion, hypoglycemia, anoxia, or severe meningitis.

Ataxic  This appears as breathing with varying tidal volumes and rates, caused by a problem with medullary chemoreceptors, but under conscious control.

Stertorous  The cheeks puff in and out in a patient with increased intracranial pressure.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Breath odor, fecal: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Distal small-bowel obstruction

With late obstruction, nausea is present although vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resultant fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, and hyperactive bowel sounds and borborygmi. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.

Gastrojejunocolic fistula

With gastrojejunocolic fistula, symptoms may be variable and intermittent because of temporary plugging of the fistula. Fecal vomiting with resulting fecal breath odor may occur, but the most common chief complaint is diarrhea, accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention, and possibly marked malabsorption.

Large-bowel obstruction

Vomiting is usually absent at first, but fecal vomiting with resultant fecal breath odor occurs as a late sign. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common with partial obstruction.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Breath odor, fruity: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Anorexia nervosa

. Severe weight loss associated with anorexia nervosa may produce fruity breath, usually with nausea, constipation, and cold intolerance as well as dental enamel erosion and scars or calluses in the dorsum of the hand, related to induced vomiting.

Ketoacidosis

Fruity breath odor accompanies alcoholic ketoacidosis, which is usually seen in poorly nourished alcoholics with vomiting, abdominal pain, and only minimal food intake over several days. Kussmaul’s respirations begin abruptly and accompany dehydration, abdominal pain and distention, and absent bowel sounds. Blood glucose levels are normal or slightly decreased.

With DKA, fruity breath odor commonly occurs as ketoacidosis develops over 1 to 2 days. Other findings include polydipsia, polyuria, nocturia, weak and rapid pulse, hunger, weight loss, weakness, fatigue, nausea, vomiting, and abdominal pain. Eventually, Kussmaul’s respirations, orthostatic hypotension, dehydration, tachycardia, confusion, and stupor occur. Signs and symptoms may lead to coma.

Starvation ketoacidosis is a potentially life-threatening disorder that has a gradual onset. Besides fruity breath odor, typical findings include signs of cachexia and dehydration, decreased LOC, bradycardia, and a history of severely limited food intake (anorexia nervosa).

Other causes

Drugs

Any drug known to cause metabolic acidosis, such as nitroprusside and salicylates, can result in fruity breath odor.

Low-carbohydrate diets

Low-carbohydrate diets, which encourage little or no carbohydrate intake, may cause ketoacidosis and the resulting fruity breath odor.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Breath with fecal odor: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Distal small-bowel obstruction

With late small-bowel obstruction, nausea is present although vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resultant fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, and hyperactive bowel sounds and borborygmi. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.

Gastrojejunocolic fistula

With gastrojejunocolic fistula, symptoms may be variable and intermittent because of temporary plugging of the fistula. Fecal vomiting with resulting fecal breath odor may occur, but the most common chief complaint is diarrhea, accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention and, possibly, marked malabsorption.

Large-bowel obstruction

Vomiting is usually absent at first, but fecal vomiting with resultant fecal breath odor occurs as a late sign of large-bowel obstruction. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common with partial obstruction. Explain all procedures and treatments.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Breath with fruity odor: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anorexia nervosa

Severe weight loss associated with anorexia nervosa may produce fruity breath, usually with nausea, constipation, and cold intolerance as well as dental enamel erosion and scars or calluses in the dorsum of the hand, both related to induced vomiting.

Ketoacidosis

Fruity breath odor accompanies alcoholic ketoacidosis, which is usually seen in poorly nourished alcoholics with vomiting, abdominal pain, and only minimal food intake over several days. Kussmaul’s respirations begin abruptly and accompany dehydration, abdominal pain and distention, and absent bowel sounds. Blood glucose levels are normal or slightly decreased.

With diabetic ketoacidosis, fruity breath odor commonly occurs as ketoacidosis develops over 1 to 2 days. Other findings include polydipsia, polyuria, nocturia, weak and rapid pulse, hunger, weight loss, weakness, fatigue, nausea, vomiting, and abdominal pain. Eventually, Kussmaul’s respirations, orthostatic hypotension, dehydration, tachycardia, confusion, stupor, and coma may occur.

Starvation ketoacidosis is a potentially life-threatening disorder that has a gradual onset. Besides fruity breath odor, typical findings include signs of cachexia and dehydration, decreased level of consciousness, bradycardia, and a history of severely limited food intake (anorexia nervosa).

Other causes

Drugs

Any drug known to cause metabolic acidosis, such as nitroprusside and salicylates, can result in fruity breath odor.

Low-carbohydrate diets

Low-carbohydrate diets, which encourage little or no carbohydrate intake, may cause ketoacidosis and a resulting fruity breath odor.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Halitosis: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Bowel obstruction

Halitosis is a late sign of both small- and large-bowel obstruction. With a small-bowel obstruction, vomiting of gastric, bilious, and then feculent material produces a related breath odor. Other findings include constipation, abdominal distention, and intermittent periumbilical cramping pain. With a large-bowel obstruction, fecal vomiting produces fecal breath odor. Abdominal pain is milder and more constant than that associated with a small-bowel obstruction and is usually located lower in the abdomen.

Bronchiectasis

Bronchiectasis usually produces foul or putrid halitosis, but some patients may have a sickeningly sweet breath odor. The patient typically also has a chronic productive cough with copious, foul-smelling, mucopurulent sputum. The cough is aggravated by lying down and is most productive in the morning. Associated findings commonly include exertional dyspnea, fatigue, malaise, weakness, and weight loss. Auscultation reveals coarse or moist crackles over the affected lung areas during inspiration. Digital clubbing is a late sign.

Common cold

A musty breath odor may accompany a common cold, which usually also causes a dry, hacking cough with sore throat, sneezing, nasal congestion with rhinorrhea, headache, malaise, fatigue, and aching joints and muscles.

Esophageal cancer

With esophageal cancer, halitosis may accompany classic findings of dysphagia, hoarseness, chest pain, and weight loss. Nocturnal regurgitation and cachexia are late signs.

Gastric cancer

Halitosis is a late sign of gastric cancer. Accompanying findings include chronic dyspepsia unrelieved by antacids, a vague feeling of fullness, nausea, anorexia, fatigue, pallor, weakness, altered bowel habits, weight loss, and muscle wasting. Hematemesis and melena are signs of associated gastric bleeding.

Gastrocolic fistula

With gastrocolic fistula, fecal vomiting is responsible for fecal breath odor, which is typically preceded by intermittent diarrhea.

Gingivitis

Characterized by red, edematous gums, gingivitis may also cause halitosis. The gingivae between the teeth become bulbous and bleed easily with slight trauma.

Acute necrotizing ulcerative gingivitis also causes fetid breath, a bad taste in the mouth, and ulcers — especially between the teeth — that may become covered with a gray exudate. Severe ulceration may occur with fever, cervical adenopathy, headache, and malaise.

Hepatic encephalopathy

A characteristic late sign of hepatic encephalopathy is fetor hepaticus, a musty, sweet, or mousy (new-mown hay) breath odor. Major late effects also include coma, asterixis (flapping tremor), and hyperactive deep tendon reflexes.

Lung abscess

A lung abscess typically causes putrid halitosis, but its major sign is a productive cough with copious, purulent, often bloody sputum. Other findings include fever with chills, dyspnea, headache, anorexia, malaise, pleuritic chest pain, asymmetrical chest movement, weight loss, and temporary clubbing.

Ozena

Ozena — a severe, chronic form of rhinitis — causes a musty or fetid breath odor as well as thick, green mucus and progressive anosmia.

Periodontal disease

With periodontal disease, halitosis occurs with an unpleasant taste. Typically, the patient’s gums bleed spontaneously or with slight trauma and are marked by pus-filled pockets around the teeth. Related findings include facial pain, headache, and loose teeth covered by calculi and plaque.

Pharyngitis (gangrenous)

Halitosis is a chief sign of gangrenous pharyngitis. The patient also complains of a foul taste in the mouth, an extremely sore throat, and a choking sensation. Examination reveals a swollen, red, ulcerated pharynx, possibly with a grayish membrane. Fever and cervical lymphadenopathy are also common.

Renal failure (chronic)

Chronic renal failure produces a urinous or ammonia breath odor. Among its widespread effects are anemia, emotional lability, lethargy, irritability, decreased mental acuity, coarse muscular twitching, peripheral neuropathies, muscle wasting, anorexia, signs of GI bleeding, ecchymoses, yellow-brown or bronze skin, pruritus, anuria, and increased blood pressure.

Sinusitis

Acute sinusitis causes a purulent nasal discharge that leads to halitosis. Besides a characteristic postnasal drip, the patient may exhibit nasal congestion, sore throat, cough, malaise, headache, facial pain and tenderness, and fever.

Chronic sinusitiscauses a continuous mucopurulent discharge that leads to a musty breath odor. Postnasal drip, nasal congestion, and a chronic, nonproductive cough may accompany the musty odor.

Other causes

Drugs

Drugs that can cause halitosis include triamterene, inhaled anesthetics, paraldehyde (which is excreted through the lungs), and any drugs known to cause metabolic acidosis such as nitroprusside.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Breath with fecal odor: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Distal small-bowel obstruction.With late small-bowel obstruction, nausea is present although vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resultant fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, and hyperactive bowel sounds and borborygmi. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.

Gastrojejunocolic fistula.With gastrojejunocolic fistula, symptoms may be variable and intermittent because of temporary plugging of the fistula. Fecal vomiting with resulting fecal breath odor may occur, but the most common chief complaint is diarrhea, accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention and, possibly, marked malabsorption.

Large-bowel obstruction.Vomiting is usually absent initially with a large-bowel obstruction, but fecal vomiting with resultant fecal breath odor occurs as a late sign. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common with partial obstruction.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Breath with fruity odor: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anorexia nervosa.Severe weight loss associated with anorexia nervosa may produce fruity breath, usually with nausea, constipation, and cold intolerance as well as dental enamel erosion and scars or calluses in the dorsum of the hand, both related to induced vomiting.

Ketoacidosis.Fruity breath odor accompanies alcoholic ketoacidosis, which is usually seen in poorly nourished alcoholics with vomiting, abdominal pain, and only minimal food intake over several days. Kussmaul's respirations begin abruptly and accompany dehydration, abdominal pain and distention, and absent bowel sounds. Blood glucose levels are normal or slightly decreased.

With diabetic ketoacidosis, fruity breath odor commonly occurs as ketoacidosis develops over 1 or 2 days. Other findings include polydipsia, polyuria, nocturia, a weak and rapid pulse, hunger, weight loss, weakness, fatigue, nausea, vomiting, and abdominal pain. Eventually, Kussmaul's respirations, orthostatic hypotension, dehydration, tachycardia, confusion, and stupor occur. Signs and symptoms may lead to coma.

Starvation ketoacidosis is a potentially life-threatening disorder that has a gradual onset. Besides fruity breath odor, typical findings include signs of cachexia and dehydration, a decreased LOC, bradycardia, and a history of severely limited food intake.

Other causes

Drugs.Any drug known to cause metabolic acidosis, such as nitroprusside and salicylates, can result in fruity breath odor.

Low-carbohydrate diets.These diets, which encourage little or no carbohydrate intake, may cause ketoacidosis and the resulting fruity breath odor.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Breath with ammonia odor [Uremic fetor]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

End-stage renal disease.Ammonia breath odor is a late finding symptom in end-stage renal disease. Accompanying signs and symptoms include anuria, skin pigmentation changes and excoriation, brown arcs under the nail margins, tissue wasting, Kussmaul's respirations, neuropathy, lethargy, somnolence, confusion, disorientation, behavior changes with irritability, and mood lability. Later neurologic signs that signal impending uremic coma include muscle twitching and fasciculation, asterixis, paresthesia, and footdrop. Cardiovascular findings include hypertension, myocardial infarction, signs of heart failure, pericarditis, and even sudden death and stroke. GI findings include anorexia, nausea, heartburn, vomiting, constipation, hiccups, and a metallic taste, with oral signs and symptoms, such as stomatitis, gum ulceration and bleeding, and a coated tongue. The patient has an increased risk of peptic ulceration and acute pancreatitis. Weight loss is common; uremic frost, pruritus, and signs of hormonal changes, such as impotence or amenorrhea, also appear.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Fetor hepaticus: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Hepatic encephalopathy.Fetor hepaticus usually occurs in the final, comatose stage of this disorder, but may occur earlier. Tremors progress to asterixis in the impending stage; lethargy, aberrant behavior, and apraxia also occur. Hyperventilation and stupor mark the stuporous stage, during which the patient acts agitated when aroused. Seizures and coma herald the final stage, along with decreased pulse and respiratory rates, a positive Babinski's sign, hyperactive reflexes, decerebrate posture, and opisthotonos.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007


 » Next page: Risk Factors for Halitosis

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