Ammonia, which has a strong, pungent odor, is a chemical compound made up of nitrogen and hydrogen. In the body, ammonia is produced when bacteria in the intestines break down protein from foods. Ammonia is then converted to urea in the liver and removed from the body through urination. However, if there is an infection in the body, the normal process of ammonia elimination may become disrupted, leading to a build-up of ammonia. This can make a person’s bodily fluids, sweat, and breath smell like ammonia.
Bacterial Vaginosis
One of the most common infections that can cause an ammonia odor is bacterial vaginosis (BV). BV occurs when there is an overgrowth of bacteria in the vagina, upsetting the natural bacterial balance. The most noticeable symptom is a foul-smelling, fishy odor coming from the vagina. However, some women report smelling like ammonia instead. This ammonia smell is thought to happen when the alkalinity of the vagina increases in response to BV.
BV affects nearly 30% of women of reproductive age. Risk factors include having a new sex partner, using an intrauterine device (IUD) for birth control, and douching. BV is usually diagnosed by a doctor after examining vaginal secretions under a microscope. It can be treated with prescription antibiotics, such as metronidazole or clindamycin creams or gels. Treatment provides relief from symptoms and reduces the risk of complications.
Kidney Disease
Kidney disease can also lead to an ammonia odor. When the kidneys are not working properly, they have trouble filtering out wastes and toxins from the bloodstream. Ammonia then accumulates and builds up to high levels. This is known as azotemia or uremia. As ammonia is exhaled through the lungs, it causes bad breath. An ammonia smell can also be detected in urine.
Kidney disease has many possible causes, including diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, and bladder or urinary tract infections. Symptoms include nausea, fatigue, swelling, breathing difficulties, and changes in urination. Blood and urine tests are used to check kidney function. Treatment depends on the underlying cause and can include medications, dialysis, or even kidney transplant in severe cases.
Signs of Kidney Disease:
- Foamy or bubbly urine
- Difficulty urinating
- Pressure or pain in lower back or abdomen
- Fatigue and weakness
- Poor appetite
- Dry, itchy skin
- Muscle cramps
- Puffiness around eyes, feet, and hands
Liver Disease
Like the kidneys, the liver plays an important role in removing toxins and waste from the blood. Ammonia is normally converted to urea by the liver. But when the liver is damaged from disease, this process can become disrupted. Ammonia then accumulates in the blood, causing an ammonia smell on the breath.
Some common liver diseases associated with an ammonia odor include:
- Cirrhosis – scarring of the liver caused by excessive alcohol use, viruses, or genetics
- Viral hepatitis – liver inflammation from hepatitis viruses like hepatitis B and C
- Fatty liver disease – buildup of fat in liver cells
- Liver cancer – malignant tumor growth in the liver
Liver disease can be detected through physical exams, blood tests, CT scans, MRIs, and liver biopsies. Treatment depends on the specific condition but may involve medications, surgery, or lifestyle changes.
Signs of Liver Disease:
- Jaundice – yellowing skin and eyes
- Bloating and fluid accumulation in the abdomen
- Easy bruising
- Fatigue and weakness
- Loss of appetite and unintentional weight loss
- Nausea and vomiting
- Pale or tar-colored stool
Bowel Obstruction
A bowel obstruction, or intestinal blockage, can also cause breath and bodily fluids to smell like ammonia. This occurs when something is partially or completely blocking the intestines, preventing the normal movement of stool. The backup of stool allows bacteria to proliferate and proteins to break down, releasing ammonia.
Common causes of bowel obstructions include:
- Hernias – part of an organ protruding through weak muscle
- Tumors – cancerous growths
- Strictures – narrowing of the intestines
- Adhesions – internal scar tissue
- Foreign bodies – objects swallowed accidentally
- Ileus – impaired intestinal contractions
In addition to an ammonia odor, bowel obstruction symptoms include abdominal cramping and swelling, vomiting, constipation, and inability to pass gas. Treatment may involve inserting a tube through the nose into the stomach to suction out excess gas and fluid while relieving the obstruction.
Dehydration
Ammonia scented sweat or urine can also be a sign of dehydration. When the body is significantly dehydrated, the liver cannot properly convert ammonia to urea. This causes ammonia to accumulate in bodily fluids.
Dehydration usually occurs because of:
- Vomiting, diarrhea, or sweating from fever
- Not drinking enough fluids
- Medications like diuretics or laxatives
Mild dehydration can be treated by drinking more water and electrolyte-containing fluids like sports drinks. Severe dehydration requires intravenous fluids and hospitalization.
Signs of Dehydration:
- Thirst
- Dry mouth and lips
- Fatigue
- Dizziness
- Confusion
- Little or no urination
- Rapid heart rate
- Low blood pressure
Urinary Tract Infection (UTI)
A UTI occurs when bacteria, usually E. coli, infect the urinary tract. This includes the urethra, bladder, ureters, and kidneys. Typical symptoms are a frequent urge to urinate, burning with urination, and cloudy, foul-smelling urine. However, some people with a UTI also notice their urine smells like ammonia.
UTIs are more common in women due to their shorter urethras. Risk factors include sexual intercourse, diabetes, obesity, and use of diaphragms or spermicides. UTIs can be diagnosed through a simple urine test and treated with antibiotics. Drinking plenty of fluids can help flush out bacteria.
Signs of a UTI:
- Cloudy or bloody urine
- Strong urine odor
- Pelvic pain or pressure
- Frequent or urgent need to urinate
- Burning sensation when urinating
- Low fever and chills
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious complication of diabetes caused by an insulin deficiency. When there is not enough insulin, the body cannot use glucose properly and starts breaking down fats for energy instead. This leads to a build-up of acids called ketones. High levels of ketones make the body more acidic, which disrupts normal metabolism. Ammonia is not converted to urea, resulting in symptoms like fruity-scented breath.
DKA tends to affect those with type 1 diabetes but can occur in those with type 2 diabetes during illness or infection. Warning signs include excessive thirst and urination, abdominal pain, nausea, and shortness of breath. DKA is a medical emergency requiring hospitalization for intravenous fluids, insulin, and correction of blood acid levels.
Signs of Diabetic Ketoacidosis:
- High blood sugar level
- Sweet, fruity breath
- Nausea and vomiting
- Rapid, shallow breathing
- Flushed face
- Confusion
- Drowsiness
Uremic Frost
Uremic frost refers to a buildup of urea crystals on the skin, causing a white, frost-like appearance. It develops when there is a high level of urea in the blood from the breakdown of proteins. Since urea is essentially crystallized ammonia, uremic frost will smell like ammonia.
Uremic frost typically signals very advanced kidney failure. It is seen in those with chronic kidney disease or acute kidney injury. Treatment involves dialysis to filter urea and other wastes from the bloodstream. Prognosis is often poor due to the extent of kidney damage.
Fish Odor Syndrome
Fish odor syndrome (trimethylaminuria) is a rare genetic disorder that causes the body to be unable to break down trimethylamine, a chemical found in certain foods. Trimethylamine then accumulates and is released in sweat, urine, reproductive fluids, and breath, creating a strong fishy odor. However, some people with this condition say they produce more of an ammonia or urine-like smell.
Foods that contain high levels of trimethylamine include:
- Fish
- Eggs
- Meat
- Dairy
- Beans
- Peas
- Soy
Treatment focuses on restricting choline-rich foods and taking antibiotics or activated charcoal to decrease trimethylamine production. Maintaining good hygiene practices can also help mask odors.
COVID-19
Recent research has found that COVID-19 infections may cause some people to have sweet, fruity or ammonia-smelling breath. Scientists think this is related to metabolic changes and inflammation processes occurring with the viral infection. The altered smell arises as the body’s immune response fights off the coronavirus in the respiratory system and other areas.
While not everyone with COVID-19 gets this symptom, doctors say an ammonia smell could be one possible sign of the disease to watch out for, along with more common symptoms:
- Fever
- Cough
- Fatigue
- Shortness of breath
- Loss of taste or smell
- Sore throat
- Headache
If you experience an ammonia odor along with other COVID-19 symptoms, getting a viral test is recommended to confirm whether or not you are infected.
Testing for Infections with Ammonia Smells
Depending on your symptoms, the following tests may be performed to diagnose an infection causing an ammonia odor:
- Urinalysis – Checks for signs of UTIs, kidney problems, dehydration, diabetes
- Vaginal swab – Screens for bacterial vaginosis
- Blood urea nitrogen (BUN) test – Elevated with kidney dysfunction
- Creatinine blood test – Measures kidney filtration ability
- Liver function tests – Evaluate liver enzyme and protein levels
- Blood glucose test – Screens for high blood sugar in diabetes
- Ketone test – Detects ketones related to diabetic ketoacidosis
- COVID-19 test – Swab or blood test to detect coronavirus infection
Your doctor will likely perform a physical exam as well, checking for signs like fever, abdominal swelling, or vaginal discharge. Your medical history and any underlying conditions will also help reveal potential causes.
Treatments for Infections with Ammonia Smells
Treatment will depend on the specific infection causing an ammonia odor. Some general treatment approaches may include:
- Antibiotics – To treat bacterial vaginosis, UTIs, and some kidney infections
- Antifungals – For vaginal yeast infections contributing to ammonia smell
- Surgery – To repair bowel obstructions or remove infected tissue
- IV fluids – To rehydrate those with dehydration or kidney failure
- Insulin – To control blood sugar in diabetic ketoacidosis
- Dialysis – To filter wastes in advanced kidney disease
- Medications – To reduce swelling, lower blood pressure, and treat infections
- Diet changes – Restricting foods high in choline or protein in some cases
Identifying and treating the underlying infection should help resolve the ammonia odor. Proper hygiene and hydration may also be recommended. However, smells may linger for some time even after an infection starts clearing with treatment. Call your doctor if smells persist or you do not improve with treatment.
Preventing Infections with Ammonia Smells
Some tips to help prevent infections that can cause an ammonia odor include:
- Practice good hygiene by bathing regularly, washing hands, and wiping properly after using the bathroom
- Urinate after intercourse to flush out bacteria
- Avoid douching, which upsets vaginal pH
- Wear cotton underwear and avoid tight clothes
- Stay hydrated by drinking plenty of water
- Get regular physicals to check for early signs of disease
- Use protection during sexual activity
- Limit alcohol intake
- Abstain from illicit intravenous drug use
- Clean cuts and scrapes right away
- Take medications and insulin as directed if you have diabetes
When to See a Doctor
You should make an appointment with your doctor if you notice any of the following:
- An ammonia smell coming from your breath, urine, or vaginal secretions
- Burning when you urinate
- Frequent urination
- Nausea, vomiting, and lack of appetite
- Unexplained weight loss
- Blood in urine or stool
- Abdominal swelling or pain
- Fatigue, muscle cramps, tremors
- Confusion
- Fever
An ammonia odor accompanied by these types of symptoms could signal an underlying infection that requires prompt medical treatment. Early diagnosis and management are important for preventing complications.
Conclusion
Infections that can make bodily fluids smell like ammonia include bacterial vaginosis, urinary tract infections, kidney and liver disease, bowel obstructions, diabetic ketoacidosis, and even COVID-19. These conditions disrupt the body’s normal metabolism and elimination of wastes like ammonia. Treatment typically involves antibiotics, IV fluids, medications, dialysis, or other approaches targeting the specific infection. Maintaining good hygiene, hydration, and healthy habits can help prevent problematic ammonia buildup. See a doctor right away if you notice troubling symptoms along with an ammonia odor.