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High levels of Trimethylamine in urine for a 4 year old - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Child Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   Hello, my daughter is 4 years old and she wets the bed (she saturates a pull-up every night). I've noticed recently (in the past few months) that her urine has a fishy odor. She also wakes up extremely thirsty and seems to have mild thirst issues during the day. She had her adenoids removed about 2 years ago and I suspect she'll need her tonsils out soon because they are enlarged. This seems to be a possible explanation for the morning thirst but the urine odor/nighttime saturation is quickly becoming a concern for me.
User :   Hello
Doctor :   Please give me few seconds to go through your query
User :   she saturates the night time diaper she wears to bed for the bedwetting
Doctor :   Ok.
Doctor :   Usually the bed wetting might be a concern as it usually stops by 2nd yr.
User :   She wakes up very thirsty and is almost angry if she isn't given water right away
Doctor :   But in some children it may prolong to 4-5 yrs or longer.
User :   And the urine has a fishy odor.
Doctor :   It si due to late myelination of the nerves when they dont have proper control on some voluntary actions .
Doctor :   I will advise regarding it once i finish treatment for this.
Doctor :   1. For eneurisis please give her a dose of 100mg of Multivitamin tablets or syrup everyday in the evning.
Doctor :   2.Please try to follow the following steps, and if you are already doing it, please be a little patient and the baby may soon get well.
Doctor :   Reassure your child that this is normal at this age and not his fault and understand that he is not doing it on purpose. Also, do not punish or blame your child for wetting the bed and make sure that other family members do not tease him about it.
*Avoid letting your child drink large amounts of fluid two hours before bedtime.
*Have your child use the toilet just before going to bed.
*Protect the bed with a plastic cover between the sheets and mattress.
*Let your child help change the wet sheets.
Consider practicing bladder-stretching exercises, in which your child will try and increase the time between urinating during the daytime so that the bladder can learn to stretch and hold more urine at night.
Consider practicing an awakening routine, in which you wake your child to urinate two to three hours after he goes to bed, either at the parent's bedtime or after setting an alarm clock
Doctor :   About the fishy odor , has it been there since her birth?
Doctor :   Or is it an acute event ?
User :   I'm less concerned with the bedwetting as I understand she will outgrow it- I am however concerned with the odor and excessive thirst.
Doctor :   Ok.
Doctor :   Trimethylaminuria (TMAU), also known as fish odor syndrome or fish malodor syndrome[1], is a rare metabolic disorder which can cause fishy odor.
Doctor :   But do you think the odor is acute or it has been thetre for quite some time.
User :   It's been over the past few months. I thought it was from the concentration of urine in the morning diaper but I also noticed it after she voided during the day. I saw the symptoms of TMAU in my online research and the odor is contained to just her urine.
Doctor :   Ok.
User :   Her breath or sweat isn't fishy smelling
Doctor :   The best way to rule out is to test for it : Doctor :   Measurement of urine for the ratio of trimethylamine to trimethylamine oxide is the standard screening test. A blood test is available to provide genetic analysis. The prominent enzyme responsible for TMA N-oxygenation is coded by the FMO3 gene.
User :   So, a simple urine test is adequate? Is it extremely rare?
Doctor :   if her sweat or breath doesnt have, she might be a carrier of the gene
Doctor :   with no full blown symptoms.
Doctor :   those individuals who carry one copy of a mutated gene but do not have symptoms. In this case, the person would be given a high dose of choline (one of the precursors of trimethylamine) and then have their urine tested for elevated levels of trimethylamine.
Doctor :   Yes, a urine test is suffice to test taht.
User :   Ok. Thank you very much. I will follow up with her pediatrician.
Doctor :   it would be the best thing to do.
Doctor :   i wish your child all the best.
Doctor :   Thank you for consulting me
Doctor :   take care
Doctor :   bye for now
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