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Fish odor syndrome.

H U Rehman1

  • 1Department of Medicine, Hull Royal Infirmary, UK.

Postgraduate Medical Journal
|January 26, 2000
PubMed
Summary

Fish odour syndrome, or trimethylaminuria, is a metabolic disorder causing fishy body odor due to excess trimethylamine. Dietary changes can significantly reduce this odor by limiting trimethylamine production.

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Area of Science:

  • Metabolic disorders
  • Human physiology
  • Microbiology

Background:

  • Fish odour syndrome (trimethylaminuria) is a rare metabolic disorder characterized by the abnormal excretion of trimethylamine (TMA).
  • TMA, responsible for a fishy odor, originates from the gut bacterial breakdown of dietary choline and carnitine.
  • The condition arises from impaired hepatic oxidation of TMA to its odorless form, trimethylamine N-oxide (TMAO).

Purpose of the Study:

  • To elucidate the metabolic pathways and contributing factors of fish odour syndrome.
  • To highlight the importance of recognizing trimethylaminuria for effective management.
  • To discuss potential therapeutic interventions for reducing trimethylamine excretion and associated odor.

Main Methods:

  • Literature review of metabolic pathways involved in trimethylamine production and excretion.
  • Analysis of dietary triggers (choline and carnitine-rich foods) and their role in exacerbating symptoms.
  • Review of pharmacological interventions targeting gut microflora to reduce trimethylamine synthesis.

Main Results:

  • Trimethylamine is excreted through breath, urine, sweat, saliva, and vaginal secretions, causing a distinct fish-like smell.
  • Impaired liver metabolism of trimethylamine is the primary cause of the syndrome.
  • Specific dietary modifications can significantly reduce trimethylamine levels and odor intensity.

Conclusions:

  • Early recognition of fish odour syndrome is crucial for patient well-being.
  • Dietary adjustments are the cornerstone of managing trimethylaminuria, reducing trimethylamine excretion.
  • Pharmacological interventions, such as antibiotics and lactulose, may offer adjunctive benefits by modulating gut bacteria.

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