Review
Classic diseases revisited
Fish odour syndrome
H U Rehman
Department of
Medicine, Hull Royal Infirmary, Hull HU3 2JZ, UK
Accepted 20 January
1999
Fish odour syndrome (trimethylaminuria) is a metabolic syndrome
caused by abnormal excretion of trimethylamine in the breath, urine,
sweat, saliva and vaginal secretions. Trimethylamine is derived from
the intestinal bacterial degradation of foods rich in choline and
carnitine and is normally oxidised by the liver to odourless
trimethylamine N-oxide which is then excreted in the urine. Impaired
oxidation of trimethylamine is thought to be the cause of the fish
odour syndrome and is responsible for the smell of rotting fish.
Certain foods rich in choline exacerbate the condition and the patients
have a variety of psychological problems. Recognition of the condition
is important as dietary adjustments reduce the excretion of
trimethylamine and may reduce the odour. Occasionally, a short course
of metronidazole, neomycin and lactulose may suppress
production of trimethylamine by reducing the activity of gut microflora.
Keywords: fish odour syndrome; trimethylaminuria
© 1999 by The Fellowship of Postgraduate Medicine
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This article has been cited by other articles:
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Arseculeratne, G., Wong, A. K. C., Goudie, D. R., Ferguson, J.
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KASHYAP, A S, KASHYAP, S.
(2000). Fish odour syndrome. Postgrad. Med. J.
76: 318a-318
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