WVAC 911: Sniffing out a medical emergency isn’t just for the dogs
Every now and then there is a news story about a pet dog that is praised as a hero for alerting his owner to her undiagnosed cancer. In addition, service dogs are trained to detect and warn their owners of an impending seizure, heart attack, high blood sugar, blood pressure problems, fainting, and asthma, just to name a few. If only humans could smell the tell-tale signs of a medical emergency and summon help. Did you know that we too, even without special breeding or being best in show, can detect the odors of potentially life threatening medical conditions? If you smell something, say something!
Imagine the following scenarios, any one of which, seeking immediate emergency care and calling 9-1-1 might be in order:
- As you enter your father’s room at his senior care facility you detect the smell of urine, ammonia and a fish-like odor.
- While visiting your diabetic sister, you smell something akin to nail polish remover on her breath.
- Your two-year-old has been vomiting since last night and now his breath smells sweet or fruity.
- Your mother isn’t feeling well and when you get close to her you notice she smells like a combination of ammonia and almonds.
- Your 16-year-old daughter suddenly begins to vomit and her vomitus smells like shoe polish.
Scenario 1: Urinary Tract Infection (UTI)
The use of adult diapers makes the elderly and disabled highly vulnerable to recurring UTIs. The warm, moist environment allows bacteria to thrive and infect the urinary tract. The same is true for persons with urinary catheters (also known as a Foley). A catheter provides multiple opportunities for bacteria to gain entry into the bladder: during insertion, during manipulation, and after removal. In addition, urethral catheters can cause irritation of the mucosal lining of the bladder, actually providing a surface for bacteria to adhere to. Failure to receive prompt medical care for a UTI can result in sepsis, a serious illness.
Scenarios 2 and 3: Metabolic acidosis
Diabetic acidosis, also called diabetic ketoacidosis (DKA), develops when ketone bodies accumulate during uncontrolled diabetes. When your cells don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that a person’s blood sugar levels have soared out of control (hyperglycemia). In essence, these high levels of ketones are poisons to the body.
Other causes of metabolic acidosis include severe dehydration due to prolonged vomiting or loss of sodium bicarbonate from the body, such as in severe diarrhea, for example.
When the oxygen level in the body is normal, carbohydrate breaks down into water and carbon dioxide. When the oxygen level is low, carbohydrate breaks down for energy and makes lactic acid. Accumulation of lactic acids can be caused by conditions such as heart failure, severe anemia, seizures, low blood sugar (hypoglycemia), alcohol abuse, liver failure, malignancy, or certain medications, just to name a few.
Scenario 4: Wounds
According to the Canadian Association of Wound Care, odor is usually caused by the breakdown of tissue. When a part of the body or section of skin is injured, anaerobic bacteria (microorganisms that do not require oxygen to thrive) invade the wound site. As they begin to degrade tissue, these cells release chemicals aptly named putrescine and cadaverine as byproducts which are responsible for the foul smells associated with injuries like pressure ulcers and drainage from wounds during the healing process.
As mentioned above, anaerobic bacteria often produce a foul, rancid or putrid smell, somewhat akin to rotten chicken soup. However, the odor produced by aerobic bacteria (bacteria that require oxygen to thrive) may not startle your olfactory system, but are just as dangerous. For example, Pseudomonas has a grape-like odor or may smell like taco chips, tortillas or corn chips to some people. Staphylococcus bacteria can smell hay-like, or have an earthy odor, while Eikenella smells like bleach.
Scenario 5: Ingested chemical, poison or drug overdoses
The chemical nitrobenzene is used primarily to produce aniline; a precursor to rubber chemicals, pesticides, dyes, and explosives. Nitrobenzene is also used to mask unpleasant odors in shoe and floor polishes, leather dressings, paint solvents, and other materials. However, nitrobenzene is also used in the production of the analgesic paracetamol, more commonly known as acetaminophen, which can also be abused and lead to overdose.
When something smells fishy, it may be that the signs of a medical emergency are right under your nose.