Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
When I was but a callow youth-either in medical school or residency I
was told[I have no reference ]that the ability to detect the odor of
acetone on a patients breath was genetic.I don't knoww whether it is
dominant or recessive.In my experience those who can detect it do so with
no training and are able to do so repeatedly with ease.Those who can not
detecct it never acquire the ability regardless of training.The important
issue clinically is that a practitioner who is unable to detect this aroma
should be awware and never in aclinical setting attempt to determine
whether a diabetic with a high blood sugar is ketotic by smell alone.