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Avatar universal

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.  
15 Responses
446474 tn?1446351282
"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
Avatar universal
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
Avatar universal
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.  
446474 tn?1446351282
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

Avatar universal
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.

Avatar universal
I have that and advanced chirrosis.  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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