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Can you "smell" high ammonia levels yourself?
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Can you "smell" high ammonia levels yourself?

I've got some unconfirmed alcoholic liver disease but I've noticed you guys in the hep-c forum really seem to know your stuff.

I'm currently half way through a slow alcohol detox (weaning down/one month) and have developed a funny transient smell in my nose that also comes out in upper body sweat (not underarm/groin).  Sometimes it is so strong it even burns my nose a bit, and others can smell it on my breath when I work closely with them.  

I have no other symptoms (brain fog, swellings, bleeding, fatigue) and my enzymes, blood and urine work are normal.  High protein foods (eggs, chicken) don't seem to set it off, though beef now makes me feel ill if I eat too much of it.  

It seems worse when I am hungry and perhaps burning aminos for fuel.  My appetite has been poor during detox and I haven't been eating well, so perhaps I'm running on amino acids and stored fat more than usual.  I took a whiff of some window cleaner, and bingo, this is the smell I'm getting in my nose and sweat.  My doctor thinks I'm crazy...  Says if I had enough ammonia in my blood to smell it in my nose, I'd have serious mental issues.  

I always thought ammonia was a later stage cirrhosis issue and not an early warning.  I didn't have this problem when I was drinking more.  It has only developed during (slow) withdrawal.  I know lots of fats come out of your liver during alcohol detox and I'm hoping this is just a artifact.  I've read in the detox forum of many who write about the strange body odors they've had during detox that resolved once they were clean.  

Worry over this is driving me crazy.  Anyone know if ammonia can be an EARLY symptom of liver disease?  If you can smell it in your nose or sweat yourself?  If you can have ammonia without mental symptoms?  

Any thoughts would be greatly appreciated!  Thanks so much for your time.  
Tags: ammonia
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446474_tn?1404424777
"I've got some unconfirmed alcoholic liver disease". What do you mean by this?

Anyone know if ammonia can be an EARLY symptom of liver disease?
No it only occurs in the most advanced liver disease. Decompensated cirrhosis.
You mention ammonia...You are probably taking about hepatic encephalopathy (HE). This is when ammonia and other toxins buildup because the liver is too damaged to filter them out. The toxins affect the brains of patience with very advanced liver disease. This only happens during the last stages of liver disease. They will be many of complications are well.

If you can smell it in your nose or sweat yourself?  
Other people can smell when a person has high ammonia levels on their breath. I have never heard of a patient who could. As with other body smells, the patient is accustomed to their own smell and can not smell it.

The smell from ammonia buildup due to advanced liver disease is called "foetor hepaticus". It is the odor of the breath in patients with severe liver disease caused by volatile aromatic substances that accumulate in the blood and urine.

Symptoms of HE are forgetfulness, confusion, inverted sleep-wake pattern (sleeping by day, being awake at night), marked irritability, tremor, difficulties with coordination and trouble writing, lethargy and eventually coma.

If you can have ammonia without mental symptoms?  
No.
Ammonia levels can be detected with a blood test so it is easy to assess.

In summary: No you don't have the indications for ammonia buildup and hepatic encephalopathy (HE).

I am not familiar with alcoholism, detox and its complications. Perhaps your issue is related to that?

If you have serious chronic kidney failure a persons breath may have an ammonia-like odor (also described as urine-like or "fishy").

Good look get sober.
Hector
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Avatar_m_tn
i can tell by the smell of digestion by-products - lol --- on the other hand alcohol and alcohol detox can affect brain chemistry - smelling unusual smells can be a symptom of brain dysfunction
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Avatar_m_tn
Thanks for the help Hector...  This odor issue has been driving me crazy and I've been getting pretty worked up about it lately.  I've had a rather close relationship with the frothy nectar (beer) all my life, but never had any health issues.  I'm middle aged now, and feel like it has been catching up with me.  Chemical sensitivities, upper right abdominal ache, strange stuff like that.  

Horace Rumpole once said "the problem with most resolutions is, they are always made too late".  When you read about alcoholic cirrhosis, it always says once you're symptomatic, it's already too late.  

Then the symptoms...  Ammonia...  Nothing else smells like it, and when people do, it's either from catabolic exercise or serious liver (or perhaps kidney) disease.  

Ammonia in my nose, breath and sweat.  I swear it smells just like window cleaner.  I just don't know what to make of it.  I thought because ammonia has such a low odor threshold, perhaps one would be able to smell it even before it rose to levels high enough to produce HE.  

I'm doing very well with the detox...  Down to two light beers a night.  No cravings or doubts about going back to where I used to be now, and less than a month to go.  When I tried to go too fast, I got a nasty post acute syndrome and decided to do a slower taper.  

This dreadful odor issue had me thinking I had made my resolution too late.  Thanks for the reassuring words.  
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446474_tn?1404424777
Glad you found it helpful.

As I said liver disease caused by alcohol or other means is relatively easy to diagnose especially when it is advanced. Ammonia buildup in the blood can be detected by a simple blood test. If you are still concerned see a doctor as they are the only one capable of ordering the tests and diagnosing if you have health issues caused by abusing alcohol.

Of course alcohol has damaged your liver. Alcohol is toxic to the liver. Because the liver is the chief organ responsible for metabolizing alcohol, it is especially vulnerable to being damaged by alcohol.The degree to which your liver is damaged is different for each person based on many known and unknown factors.

Before I forget..."High protein foods (eggs, chicken) don't seem to set it off, though beef now makes me feel ill if I eat too much of it." Red meats are harder to digest then chicken, fish or eggs. Person with HE need to avoid red meats as it will increase the amount of ammonia in the small intestine which will travel to the brain.

Good luck in quitting alcohol.
Hector

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Avatar_m_tn
I have been diagnosis with severe NASH and also HE. My liver biopsy showed no cirrhosis but did show fibrosis. I have had blood test that showed high ammonia levels. I have times were I don't seem to know where I am at. I have had times were I get very dizzy and will fall. There are times when I can't remember my kids name. There are also times when I can't remember how to write certain numbers. I also have bouts of anxiety and will start fussing and cussing for no real reason. So yes you can have HE without having cirrhosis.

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Avatar_f_tn
I have that and advanced chirrosis (cirrhosis).  High levels of ammonia detected by the blood tests.  I can't smell it myself but there is physical evidence of it. Drinking makes it worse, I have had a couple of glasses of wine and my body doesn't process it, people said that I smelled like I had been drinking 2 days after.  Good luck with your detox,
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Avatar_f_tn
I have had the same thing, I get dizzy and I have fallen down and have had concussions, does hep-c cause thatmy doctors say I am not a candidate for peginterferon, I was diagnosed 12 years ago before the fda even approved it, have had 4 specialists and they have all given up on me, but I'm still here!
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Avatar_m_tn
I am not a drinker and am not going through a detox I do however have diabetes pretty severe and other health problems and nobody can smell ammonia on me but I smell it very strong completely out of the blue many times a day.  If anyone can give me advice about this I would appreciate it.
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Avatar_m_tn
Cheers! As always your opinions are always welcomed and detailed.

I've had “Brain Fog” but not due to hepatic encephalopathy. Since at least my teens sleep apnea, symptoms of ADHD and personally disorder long before HCV exposure plus chronic HCV related ones after exposure.

http://www.hcvadvocate.org/hepatitis/hepc/hepatic_encephalopathy.html
excerpt
What about “Brain Fog”?
Hepatic encephalopathy should not be confused with “brain fog”—the mild lack of concentration, forgetfulness, or absent-mindedness that is common in people with chronic hepatitis C and those receiving HCV treatment. Several studies have shown some degree of cognitive impairment, memory problems, and reduced concentration in people with hepatitis C who do not have advanced disease.
The cause of “brain fog” is not well understood. Some experts believe that HCV itself may affect the central nervous system, or that the virus may alter or stimulate the immune system in ways that impact the brain. In addition, “brain fog” may be related to fatigue, lack of sleep, stress, depression, or side effects of interferon. But in people without advanced cirrhosis, the liver is usually still able to process toxins and blood usually still flows well through the liver. Thus, “brain fog” cannot be assumed to be an early manifestation of hepatic encephalopathy—even though the signs of “brain fog” and some of the symptoms of grade 0 or grade 1 encephalopathy may be similar.

Causes of Musty sweet breath odour
Noticed that most causes were related to advance liver disease

Hector, What about Ketone? My opinion Seams like environmental exposure, prescription and illegal drug intoxication can cause similar Musty sweet breath odor. Obviously depending on the amount and length of exposure toxic levels very well may result in liver and kidney failure due to acute or chronic use. Using prescription drugs over the prescribed dose or not promptly taking recommended action per complete prescribing information and/or doctors instructions.      

http://www.rightdiagnosis.com/symptoms/musty_sweet_breath_odour/causes.htm
Ketone link
Ketone: functional group of an organic compound in which a carbon atom is double-bonded to an oxygen; neither of the other substituents attached to the carbon can be a hydrogen.

I see my gastro every six months, primary one or twice in between gastro and now treatment NP.  Have noticed that all of them check for "flapping" and carefully examine my abdomen, check my body, mouth, extremities for swelling and skin condition, ask me about pertinent symptoms, besides the routine like listen to heart, lung stomach and other.  I guess that's ONE real good indication that my providers are on top of their physical exam for those with chronic HCV.
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Avatar_m_tn
Will I have had elevated ammonia levels a couple of times in the past few years, and yes I could tell with certainty when it occurred. Not sure if "smell" is the right word for me but I knew when the levels were elevated.  There is a blood test to confirm this.  Ask you doc.  Also take lactulose or rifaximin to reduce ammonia levels.  Reduce animal protein intake.  There is a definite correlation between brain fog/HE and elevated ammonia levels.
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446474_tn?1404424777
I can only comment on what I know about from either personal experience or the experience of close friends or in my studies of hepatology. Hepatitis C, liver disease, liver cancer (HCC) and liver transplantation. Your other condition I I have no knowledge of.

Jimmy, from your profile...
FS-FIBROSIS STAGE* (V2) F3 - Bridging fibrosis many septa
when was this test done?
This was a liver biopsy?
Hepatic encephalopathy ONLY appears in those with stage 4 liver disease (cirrhosis) and not everyone with cirrhosis experiences it.

"Brain fog" and HE are completely different symptoms from two different causes and those of us that have experience with both can easily tell the difference. I had HE for many years when I had cirrhosis and I know many others that have been hospitalized because of the stupor and coma it can cause.

You are treating your hep C now. Correct?
If so I wouldn't worry about anything caused by your hep C or liver disease as you have over a 90% chance of cure. Your hep C will be cured and whatever liver disease you have will be reversed. This is really a best case scenario. It doesn't get any better than that.

Best of luck to you!
Hector
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Avatar_m_tn
Thank you,  Yes April 30 will be week 4 VL should be undetected when results come in the following week.  Pretreat 800+k wk 2  detected <12
July 2013 FibroSure FS-FIBROSIS STAGE* (V2) F3
June 2012  biopsy  Stage 2 Grade 2
2000 biopsy Stage 2 Grade 1  

I am not worried 'I've had “Brain Fog” but not due to hepatic encephalopathy" and learned that a few months ago.

Commented about that with a link for anyone who might not be aware of the differences similar to me when I first read about it last year.

Main question was about Ketone and other causes when first noticed. That may not indicate current advance liver disease but could with continued or toxic level exposure result in advance liver disease. Are there any other possible causes of a Musty and/or sweet breath odor that is really not that dangerous?  

Are there any differences between "high ammonia levels on their breath" and Musty sweet breath odor that could be confusing?
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