Q:  BP Son's Breath Odor & Ketones

 
Dear Dr. Phelps, I just read a question from a previous post that stated the the writer's wife's breath gets very bad when she is cycling (?).  Your response indicated that the odor may be due to Ketones. Could you elaborate on this issue?  Our 13 year old son has been diagnosed BP. His breath is terrible.  My husband has been pointing this out to our doctors for years, but you are the first one who thinks that there may be a link.  Right now we are seeing some signs of mania, but overall his medication seems to be holding it at bay.  Please help.


Dear Ms. K' -- 
First I should note that I've never seen someone with this problem, nor heard from a family member about it, so I have no direct experience.  The only thing I remember from medical school about breath smell that relates to mental health symptoms is the ketone idea.  Ketones can be measured in the urine, so there would be a way to investigate this with a simple urinalysis -- but probably with little point to it, as the way to treat ketosis is simply.... eat something!  If there is no change in the breath odor even after eating and other evidence (such as not looking for yet more to eat) that his body seems to think it's been fed, then the likelihood this has anything to do with ketones goes way down.  

So instead, as you're the second one describing this, I'm going to be on the look-out for the breath smell as a marker for emerging symptoms, as that's the only place where I can imagine some use for it.  However, perhaps you wonder if there's some way this finding could turn into some key to understanding the illness, as it's so obvious a change for your son too.  If  I ever get a chance to pass along that curiosity in a context where the idea could get picked up, I will (especially if I find a case like this in my practice!). 

Dr. Phelps

Published March, 2003