Fetor hepaticus is associated with severe liver disease, which causes scarring and poor functioning of your liver. This can result in portal hypertension, which refers to increased blood pressure in the veins of your liver. Portal hypertension makes it hard for blood to flow through your liver, so it gets backed up in the veins surrounding your liver. When blood doesn’t pass easily through your liver, the toxic substances that would usually be filtered out by your liver make their way to other parts of your body, including your lungs. When this happens, you might smell traces of these substances when you exhale. Dimethylsulfide is likely responsible for the distinct smell of fetor hepaticus.