Concerned about Husband's Breath Odor when He's Depressed
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Q:  Concerned about Husband's Breath Odor when He's Depressed

My husband has had a seizure disorder since the age of 30.  He is now 51.   He has been treated a few times for major depression.  In the last six years he has had periods of mania, and major depression.  He has finally been diagnosed with Bipolar.  My concern is that every time he goes into a depressed state, his breath becomes fowl.  It is not sweet but smells like moth balls.  This odor is so strong that it fills our bedroom, recreation room, and even the car.  My daughter has even commented that he smells like an old man.  He has had three bladder infections in the last nine months.  Doctors have commented over the years that he passes ketones in his urine.  His mother did develop diabetes in her 40's.  Should I be concerned that there is something else going on in his body?

Dear Ms. A --
A simple explanation may exist.  If that's not correct, then I really don't know what is going on here. 

You mentioned ketones in his urine.  You may already have learned that ketones are produced when people are not eating.  It is the body's way of providing an additional fuel in the bloodstream (particularly when someone is not eating carbohydrates).

When ketones circulate in the bloodstream, they diffuse across the lung wall into the air that we breathe (just like carbon dioxide), and thus some of them are present in the air that people are exhaling, if they are making ketones.

Ketones have a distinct odor.  It is quite strong.  Often times it is described as "sweet", sometimes "musty".

Well, that's funny: I just did a search on Google using ketones breath smell and the third link was a letter I wrote five years ago right here on BipolarWorld, in answer to a woman describing a similar observation.  Here is that story.  I still haven't seen such a case in my practice, but I'll bet that's what's going on.

Dr. Phelps

Published November, 2008


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