Pt stool smells like fish

[BrendaH84, BSN]

Where I work we have many long-term pt's. Three of them ALWAYS have stools that are soft and always smell strongly of a fishy iodine type smell. is this c diff? I had asked if it was c diff and someone said that one of them had been tested for it twice and it came back negative. I guess it could still be positive.

None of those three are on any daily supplement either. so it's not that. it's a very distinct odor that even visitors comment on.

The interesting thing is even when this one lady has a regular firm stool, it STILL smells like that. for three people to all have the same smell in their stool, I would guess it's an infection of some sort.

Someone I work with is from Cuba, she said, oh that smells like cholera. what! lol, anyway what do you all think?

[Meriwhen, ASN, BSN, MSN, RN]

Let me ask the obvious: are they eating a lot of fish?

[BrendaH84, BSN]

Let me rephrase the question.

Can you describe what c diff smells like?

[Fiona59]

The stench of Cdiff is never forgotten. We describe it as a horse barn type odour.

[LadyFree28, BSN, LPN, RN]

C diff does NOT smell like fish.

Maybe the fish smell could be a vitamin or mineral deficiency. Selenium smells like fish to me-ask me how I know.

[icuRNmaggie, BSN, RN]

I have noticed a yellow or orange color and a strong ammonia smell of the stool and urine in pt's with liver failure.

Consuming asparagus and taking fish oil capsules can create some pretty funky odors as well.

[xoemmylouox, ASN, RN]

Cdiff does not smell like fish. It's a smell you never forget, yet I can't quite describe it. I've never had a CDiff pt with firm stools either.

How long have their stools smelled like this? Do they have any abdominal cramping? Are they tube fed or do they eat the same food as anyone else? Any unusual supplements like kelp?

[icuRNmaggie, BSN, RN]

cdiff is an anaerobic bacteria that causes massive yellow diarrhea with an unmistakable yeasty moldy odor.

[KelRN215, BSN, RN]

BrendaH84 said:

Let me rephrase the question.

Can you describe what c diff smells like?

It smells like rotten poo, not fish. Stool samples were sent and were negative. I doubt it's C-Diff. If these patients are regular patients on your unit perhaps it's something in your food.

[jadelpn, LPN, EMT-B]

There are many other smelly bacterias that can be in stool that is not c-diff. I would advocate for a stool culture. Also, a bacterial vaginosis can cause a fishy smell, therefore, it may not be specifically the stool that smells. Again, I would advocate for testing. Urine can also have a fishy smell, which can be a UTI.

Supplemental drinks, lactose, wheat, sugar....some elderly can not digest any of these well, and it can cause a distinct fishy odor. As can some lipid lowering medications. If dietary is using flax seed in anything they cook it can as well, also eggs can also give off a sulfur (fish like) smell to stool after digestion--and so can yogurts/sour cream/aged cheeses. Also, if the resident has diverticulitis, colitis, irritable bowel--all cause some intense odors, all can cause both loose stool and/or constipation.

If a stool culture has ruled out the presence of bacteria not conducive to bowel health, if there's a culture that rules out a BV (which males get as well) it is more than likely a dietary thing. And most importantly, if the resident is not having nausea, indigestion, or otherwise uncomfortable, a quick clean up would be all that I would pursue at this point. If they are happy, healthy, and eating, all's well in the world.

[roser13, ASN, RN]

I vote for fish oil supplements.