Rotten apple smell in breath

Introduction Most patients with diabetic ketoacidosis have polyuria, polydipsia, polydipsia and fatigue several days before the disturbance of consciousness, followed by loss of appetite, nausea, vomiting, often accompanied by headache, lethargy, irritability, rapid breathing, exhalation There is a rotten apple flavor (acetone) fatty acid oxidation product acetyl CoA, which is not only the precursor of ketone body, but also an inevitable way to eliminate ketone body. Acetyl CoA combines with oxaloacetate, a product of sugar metabolism, to form citric acid, and then enters If the tricarboxylic acid is recycled, if there is not enough sugar metabolite oxaloacetate, the elimination of the ketone body is impeded.

Cause

Composition and metabolism of ketone bodies: Ketone bodies are products of incomplete oxidation of fat , including three components of acetoacetic acid, -hydroxybutyric acid and acetone. Among them, acetoacetic acid is a strong organic acid, which can react with ketone body powder; -hydroxybutyric acid is a reduction product of acetoacetic acid, also a strong organic acid, which is the largest in ketone body, accounting for 70% of total ketone body. %; acetone is the decarboxylation product of acetoacetate, the least amount, neutral, no renal threshold, can be discharged from the respiratory tract. Normal human blood ketone body does not exceed 10mg / dl, ketoacidosis can increase 50 to 100 times, urine ketone positive.

an examination

Related inspection

Urine sugar blood pyruvate

It is characterized by increased respiratory rate and deep breathing, which is caused by acidosis. When the blood pH is <7.2, it may appear to facilitate acid drainage. When the blood pH is <7.0, the respiratory center may be inhibited and respiratory paralysis may occur. Some patients may have a odor of ketone similar to rotten apple flavor in their breath.

Differential diagnosis

1. Breathing gas is rancid smell: Breathing gas is rancid smell is due to the growth of bacteria under the purulent sputum, the protein in the purulent sputum is decomposed and decomposed, resulting in a foul odor. Atrophic rhinitis is a slow-developing nasal atrophic inflammation characterized by atrophy of the nasal mucosa, periosteum, and bone. Severe with a typical bad smell, called ozena. More often than adolescence, women are more common than men.

2. Breathing gas is a smell of urine: If the kidney is sick and causes renal failure, these poisons cannot be excreted in time, and thus will stay in the blood, causing water and salt metabolism disorders, forming uremia. When the concentration of toxic substances in the blood increases, some volatile toxic substances are excreted from the respiratory qi of the lungs, so there is a smell of urine in the uremic patients' wards.

3. Breathing gas is the smell of garlic: Breathing gas is a symptom of organophosphorus pesticide poisoning. The important signs of organophosphorus pesticide poisoning are due to the increase of glandular secretion. The poisoned person has more "garlic smell" in the mouth and respiratory tract. Flavor secretion.

4. Breathing gas is alcoholic: Breathing gas is a symptom of alcoholism due to alcoholism. Alcoholism refers to mental and physical disorders caused by drinking. Alcoholic dependence refers to a series of withdrawal symptoms when a chronic alcoholic person stops drinking. In fact, alcohol dependent people are often in a poisoned state. The incidence of alcoholism in China is lower than that in Western countries, but its incidence has appeared to increase in recent years and should be taken seriously.

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