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Symptoms and Signs – Differential Diagnosis of Breath Odor • Sweet, fruity: diabetic ketoacidosis (DKA), starvation ketosis • Musty fish, clover: fetor hepaticus (hepatic failure) • Halitosis: tonsillitis, gingivitis, respiratory infections, Vincent’s angina, gastroesophageal reflux, Helicobacter pylori infection, Zenker’s diverticulum • Foul, putrid: nasal/sinus pathology (infection, foreign body, cancer), respiratory infections (empyema, lung abscess, bronchiectasis) • Foul, feculent: intestinal obstruction/diverticulum • Fishy, stale: uremia (trimethylamines) • Cinnamon: pulmonary TB • Ammonia-like: uremia (ammonia) • Achalasia 
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