Question from the clinician: malodorous breath, hair, and body.

Abstract

Malodorous breath, hair, and body in otherwise healthy preadolescents always have perplexed me. Despite mouthwash, shampoo, and deodorant, I never have found an adequate solution. I would appreciate some expert advice.The inborn error of metabolism condition known as trimethylaminuria gives a fish odor to sweat, urine, and breath. It is due to accumulation of trimethylamine in the body. The defect is an impairment in the ability of the liver enzyme trimethylamine-N-synthetase to break down trimethylamine from choline and trimethylamine oxide in the diet. This is an autosomal dominant genetic trait or can occur following treatment with high doses of the drug L-carnitine. Treatment with a low-protein, low-lysine diet may relieve the problem.A reader raised the question of the use of steroids and bronchodilators for patients who have bronchiolitis. Dr. Margaret Guill’s thoughtful response is printed in the electronic edition of the August 2003 issue of Pediatrics in Review.