^

Health

Metallic taste in the mouth: what does it mean

, medical expert
Last reviewed: 23.04.2024
Fact-checked
х

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.

If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.

If you have a metallic taste in your mouth, this can be a sign of poisoning or internal intoxication of the body, which occurs in the background of any obvious or hidden diseases. In any case, whether it is the only symptom or a part of interrelated discomfort, it is better to consult a doctor. To begin with - to the district therapist. If necessary, he will refer to other specialists.

What does metallic taste mean in the mouth?

May be a sign of bacterial infection. For example, enterococcal infections affecting the intestines are similarly manifested. With a high viral load of hepatitis viruses, with any renal pathologies, a similar sensation may appear. A similar picture can be observed with carbon monoxide poisoning, other gases, with the destruction of hemoglobin on the background of various serious diseases. If you have recently returned from warm tropical countries, this may indicate parasitic invasion, or the initial stage of malaria. Thus, it is impossible to say unequivocally what exactly a metallic taste in the mouth means. Even if such a feeling arose once and for a short time, you need to consult with your doctor.

Causes of the metallic taste in the mouth

The reasons can be quite a lot, depending on the pathogenesis and etiological factor. This may be the destruction of red blood cells as a result of anemia, multiple hemorrhages, blood cancer. Also, a similar pattern is observed in case of poisoning with any substances, but first of all - carbon monoxide. It can develop against the background of severe damage to the kidneys and liver, with heart and pulmonary insufficiency, cirrhosis of the liver, and kidney pathology. The reason may be a violation of hormonal levels, changes in the composition of the blood, changes in the microbiocenosis, quantitative and qualitative characteristics of viruses. The reason may be poisoning with toxic substances, poor-quality alcohol, spoiled products. Bacterial endotoxins. Such a feeling often occurs with severe viral and bacterial diseases, malaria, exhaustion of the body, kidney and liver diseases.

trusted-source

Risk factors

The risk group includes people suffering from chronic infectious diseases, patients with dysbacteriosis and impaired normal microbiocenosis in any biotopes. The risk group should include all people with acute and chronic diseases of the kidneys, liver, cancer patients, patients who have recently undergone surgery, anesthesia, anesthesia. The risk group includes people returning from hot countries where there is a risk of parasitic, bacterial invasion.

This includes people who have not been vaccinated against major infections, seriously ill patients, people with poisonings. Or those who, by virtue of their professional duties, are forced to come into contact with microorganisms, viruses, are in contact with infectious patients (microbiologists, bacteriologists, virologists, epidemiologists, infectious disease specialists, employees of infection control centers, laboratories, museums of microorganisms, research institutes and their departments, infectious diseases hospitals and departments, etc). Physicists, chemists, biochemists, technologists, pharmacists, biotechnologists who have constant contact with chemicals, reagents, and active ingredients are at risk. This also includes X-ray technicians, staff at ultrasound examinations, and other staff, often exposed to various types of radiation.

People who are regularly exposed to poisons, toxins, organic and inorganic substances, for example, fertilizers, insecticides, herbicides, building materials and repair materials, are at risk. As additional risk factors, pregnant women should be considered, since they have many changes in their bodies, including tactile, taste, and tactile sensations. Toxicosis, internal intoxication may develop, and therefore such sensations appear. A similar picture is observed in case of poisoning by mushrooms, foodstuffs, alcohol, medicines, chemicals. Separately, children, elderly, adolescents are considered, because at each of these stages of the life cycle hormonal changes occur, which can lead to a violation of sensitivity, or more often poisoning occurs, higher susceptibility to them.

Metallic taste in the mouth can appear in patients with diseases of the kidneys, liver. Often observed with cirrhosis of the liver, with stomatitis, erosions and ulcers, bleeding. Often this is seen with a hangover, in people prone to alcohol abuse, in chronic alcoholics, or drug addicts.

trusted-source[1]

Pathogenesis

The basis of pathogenesis is two processes. On the one hand, this may be a violation of the sensitivity and susceptibility of the receptors, which leads to false symptoms of intoxication. A similar picture is observed with alcohol abuse, with neurosis, with overeating, with stress, and so on. Violation of perception can lead to hormonal changes, changes in the composition of microflora, mucous secretions, as a result of which a metallic taste appears. This can be observed with bleeding, bleeding of individual organs and tissues. During pregnancy, menstruation, lactation, post menopause, and the senile period, there is a sharp change in susceptibility, and various unpleasant tastes in the mouth, including metallic taste and odor, may appear.

The second reason is poisoning, which is quite often accompanied by the appearance of metallic taste. Especially often this is observed in carbon monoxide poisoning. A person may not feel any other signs of poisoning, and not even feel the smell of gas, but the feeling of metallic taste should be alerted. In this case, the basis of the pathogenesis is the development of the intoxication process, damage to blood cells, possible damage to the liver, destruction of red blood cells and the release of free hemoglobin into the blood. In case of true poisoning, the features of further pathogenesis depend on the way in which the poison penetrates the human body. Toxic substances enter the body in one of the known ways - through the respiratory tract, through the gastrointestinal tract, or through the mucous membranes and skin. Let us consider in more detail what happens in each of the cases.

So, if poisoning occurs through the respiratory tract, the poison passes through the nasal passages, nasopharynx, affects the bronchi and lungs. The result is a burn of mucous membranes, further penetration of toxins into the respiratory cells and tissues. The epithelium dies off, there is a change in the microflora, the composition of mucocial clearance changes, which includes mucous secretions, synthesized substances, cellular and tissue elements. This entails a metallic taste. Also, there is an additional stimulation of the ciliary epithelium, the development of edema and irritation in the mucous membranes of the upper and lower respiratory tract. A new microflora may appear, with completely different characteristics and properties. This may also be accompanied by a metallic taste. Accumulation of toxic substances occurs in the alveoli. There is their absorption, absorption through the cell membrane. The substance is absorbed and then enters the blood, where the main toxic effect is carried out. Once in the blood, the poison destroys the red blood cells, which entails the release of hemoglobin. It is known to consist of four iron atoms, as a result of which the taste of metal in the mouth may appear.

When penetrating through the digestive tract, a burn of the esophagus, oral cavity, and stomach develops in a similar way. This entails a change in the composition and qualitative characteristics of the microflora, the mucociliary matrix, causes irritation of the receptors, the dying of the epithelium, cilia. Changes microflora. Separately, it is worth noting the ability of the poison to cause erosion and gastric bleeding. In this case, the taste of the metal in the mouth may also appear, since the blood contains red blood cells and hemoglobin, as a result of which they acquire a characteristic flavor. The main absorption occurs through the walls of the large intestine, then through the walls of the small intestine. After absorption, the substance enters the bloodstream, and then has a toxic effect there. The mechanism of action is similar to that when the poison enters the respiratory tract (in the blood the poison acts the same, regardless of the way in which the poison enters the body). The destruction of red blood cells and the release of free hemoglobin into the blood, resulting in a metallic taste.

The substance is transported to the blood, then the poison penetrates the liver, where a number of transformations take place. Basically, the poison is neutralized. This entails a violation of the functions of the blood, liver and kidneys.

trusted-source[2], [3], [4], [5], [6], [7]

Epidemiology

According to statistics, in about 78% of cases, a metallic taste in the mouth is a sign of poisoning. As a poisonous substance various chemical, biological substances can act. Most often, poisoning develops as a result of exposure to the body of carbon monoxide, because it leads to a sharp destruction of red blood cells. The taste is caused by the release of hemoglobin into the free blood stream (approximately 95% of all poisoning, accompanied by the appearance of metallic taste in the mouth, is caused by carbon monoxide). The remaining 5% of poisonings account for various chemicals, bacterial toxins, and poisons of fungi. In any case, the taste is due to hemoglobin, as well as neurovegetative stimulation of the nerve receptors. In 3% of cases, the cause is a severe viral or bacterial infection, parasitic invasion. Approximately 3-4% due to hormonal and immune pathologies.

trusted-source[8], [9], [10], [11], [12], [13],

Symptoms

The first sign is the appearance of a light metallic taste in the mouth. It may also be accompanied by dryness, burning sensation, a sensation of fever in the throat, nose.

Metallic taste in men’s mouth

In men, the appearance of metallic taste in the mouth may indicate the development of pathology of the kidneys, liver, urinary tract, the development of a latent infection, or a sexually transmitted infection. This taste may be in smokers, in people with alcohol dependence, or vice versa, for those who have not drunk for a long period of time. It may be a sign of a bacterial infection, some viral diseases, poisoning, or it may indicate a parasitic infection. It is not necessary to exclude blood diseases, including iron deficiency anemia. If you experience these symptoms, you need to consult a doctor and undergo a comprehensive examination.

Metallic taste in the woman’s mouth

There can be a lot of reasons, and all of them are strictly individual. Therefore, in order to find out why a woman has such sensations, you need to undergo a comprehensive examination. This is usually attributed to the peculiarities of metabolic processes, as well as hormonal background, the course of biochemical and metabolic processes. Such sensations often occur during hormonal changes: during pregnancy, before menstruation or after it, in menopause. Older women often feel a metallic taste in their mouths. Often appoint a consultation with a gynecologist-endocrinologist, who will help to understand and find out the cause. But you need to understand that the list of possible causes is not limited to these points. Examination can show extremely surprising reasons, and very unexpected ones. This may include digestive disorders, dysfunctions of the kidneys, liver, spleen, bile stasis in the gall bladder, low enzyme activity, vitamin deficiency, poor nutrition, insufficient fluid intake, general biochemistry disorders, immunity disorders, dysbacteriosis and digestive disorders, disorders of microbiocenosis in various biotopes.

Metallic taste in the mouth before menstruation

Before menstruation, hormonal changes occur, the composition of the microflora changes, as a result of which a metallic taste appears in the mouth. Usually the sensations are normalized either when the menstruation began, or a few days after it. 

trusted-source[14]

Metallic taste in the mouth during pregnancy

Quite often in women during pregnancy, a metallic taste appears in the mouth, smells and tastes change, and sensitivity changes. This may be due to hormonal changes, increased stress on the body. Under the action of hormones, the sensitivity and susceptibility of the receptors are significantly reduced. This leads to the emergence of various unusual tastes, to the perception of various odors, increased sensitivity, distortion of tastes and sensations.

This process is also supported by a certain state of the neuroregulatory systems, including the nervous, endocrine, and immune systems. It is determined by the state and activity of the pituitary-hypothalamic system and the epiphysis, which stimulate the production of neurohormones of neuropeptides, which, in turn, trigger a number of chain mechanisms and cascade reactions that support the entire body. Also, these processes support adaptive resources, regulate the dominant of pregnancy - a condition in which only those areas responsible for motherhood, carrying the child parental behavior remain the most active, while other brain functions are sharply dulled.

But it must be borne in mind that such a mechanism is often a sign of pathological reactions occurring in the body. For example, the characteristic metallic taste may indicate a pathology of the kidneys, liver, an exacerbation of gastrointestinal disease. A similar picture is observed with blood diseases, bleeding, with anemia and the destruction of hemoglobin, with injury and the risk of miscarriage, spontaneous abortion or premature birth. Could be one of the signs of rhesus conflict. To eliminate all risks and prevent an unfavorable outcome of pregnancy, you need to consult with your doctor. It may need a more detailed examination and further treatment.

trusted-source

Diagnostics of the metallic taste in the mouth

The basis of the diagnosis is to determine the exact reason for which there was a metallic taste in the mouth. Then determine the main changes that have occurred in the body, and assess the severity of the pathological process. It all depends on what changes occur in the body. To make a diagnosis, you need to contact the district therapist or pediatrician, and he will prescribe the necessary diagnostic regimen. If necessary, additional consultations of experts will be appointed. It is important to know the patient’s history. To do this, you should conduct a detailed survey of the patient, ask how long these feelings have appeared. The patient should describe his subjective sensations in as much detail as possible, remember how long and under what circumstances they appeared. Are there any factors that strengthen or weaken the condition. Then the doctor conducts the examination. Often prescribed clinical tests (standard - blood, urine, feces). They will help determine the approximate direction of further diagnosis and suggest that the body can be broken. From this will depend on a further set of diagnostic methods.

It is on the basis of this that one can make a basic assumption regarding the cause of the appearance of metallic taste, on the basis of which further examination will be appointed. The earlier the diagnosis is made, the greater the chances of a successful outcome. Therefore, when the first complaints appear, you need to see a doctor as soon as possible. Usually, after making a preliminary diagnosis, the patient is referred to a highly specialized specialist, who conducts further examination and selects the appropriate treatment.

trusted-source

Analyzes

At the initial stages, standard tests are prescribed - a clinical blood test, urinalysis, feces analysis. This will allow you to orient yourself in what is happening, and determine the reason why a metallic taste appears in the mouth. In the future, the set of analyzes is determined directly by the specialist who conducts the observation. It all depends on the presumptive diagnosis.

For example, if poisoning, intoxication, autoimmune pathologies, toxicosis are suspected, toxicological analysis and biochemical research are the main research methods. During toxicological analysis, toxin. During the biochemical study - the main changes in the body. If liver pathology is suspected, a biopsy, biochemical blood test, bile test, bilirubin test, etc. May be required. In case of suspicion of kidney pathology, various urine tests are submitted - clinical, biochemical, sediment analysis, Necheporenko analysis, test of three glasses, bacteriological urine culture and others.

Such analyzes as daily monitoring of diuresis, wash water analysis, biopsy with further cytology and histological biopsy, microscopic examination (biopsy, scraping, biological fluids), an immunogram, serological, immunological, allergological methods, bacteriological cultures, virological diagnostics, rheumatic tests and tests for tumor markers.

trusted-source[15], [16], [17], [18], [19]

Instrumental diagnostics

At the initial stage, as a rule, they manage with a standard inspection, physical examination. They make a preliminary diagnosis and then send it to a specialist for consultation. He is engaged in further diagnosis. A set of tests for instrumental diagnostics, respectively, will depend on which doctor conducts the diagnosis. The bottom line is that you first need to identify the cause of the pathology, then the area of damage, identify those organs and systems that have undergone the greatest pathology. Methods depend on it.

For example, if you suspect the development of any disease of the gastrointestinal tract, liver, pancreas, gastroscopy, X-ray, ultrasound, colonoscopy may be required. If the respiratory system is suspected, the following test methods may be used: spirogram, radiograph, functional tests, fluorography. If kidney and urinary tract diseases are suspected, an x-ray of the kidneys, rheography, and ultrasound are used. Electrocardiogram, angiography, ultrasound, magnetic resonance and computed tomography, X-rays are almost universal methods of research that are used in all areas.

trusted-source[20], [21]

Differential diagnosis

It happens that the survey data and inspection is not enough for a diagnosis. For example, several diseases have similar manifestations. But for the selection of adequate treatment, you need to know the exact diagnosis. Then differential diagnosis is applied. If necessary, instrumental methods of research, laboratory tests can be assigned. An additional expert consultation may be held. In particularly difficult cases, a council or a medical board is convened.

trusted-source

Treatment of the metallic taste in the mouth

Etiological and symptomatic treatment. Etiological treatment implies a focus on eliminating the cause that caused the metallic taste in the mouth. Symptomatic therapy implies the need to eliminate the symptoms and pathological processes occurring in the body. One of the main means is the treatment of the organism as a whole, at the system level. For the treatment used various methods. Methods of treatment are determined in the first place, the cause and pathogenesis, complaints, data of an objective examination, and the patient's subjective sensations. Usually used complex therapy, which includes medical, physiotherapy, means. From drug therapy using various drugs. From physiotherapy, thermal procedures, hydro procedures, massage, hardening, physical therapy, gymnastics, proper breathing and meditation work well. Folk, homeopathic remedies, herbal medicine help.

What if there is a metallic taste in the mouth?

It must be clearly understood that a metallic taste in the mouth may appear for various reasons. What to do if it appears depends on these reasons. There are at least two options - either this is carbon monoxide poisoning, or one of the symptoms of a disease. If this is a sign of the disease, then independently, without diagnosis, you can not do anything. Therefore, the only thing that is required of you is to consult a doctor and be examined. The sooner this is done, the better.

In the second case, you need to make sure that you do not continue to inhale carbon monoxide. Its effect on the body should be stopped as soon as possible. To do this, you need as soon as possible to provide access to fresh air, after which you immediately need to call an ambulance, and in the meantime to provide emergency assistance.

In case of poisoning, the main treatment consists primarily of correct and quick first aid to the victim. The life of the patient depends on it. There is an algorithm for emergency care in case of poisoning:

  1. Providing emergency care (stopping the further flow of poison into the body; removing the poison that has already penetrated from the body; neutralizing the poison that has entered the bloodstream).
  2. Maintenance of vital body functions (detoxification therapy; anesthetic treatment; symptomatic treatment; pulse, respiration, pressure, pupil reaction to light).
  3. Basic therapy aimed at eliminating the pathological process, the effects of poisoning (pathogenetic therapy; etiological therapy). It turns out, as a rule, after hospitalization.
  4. Recovery activities (at the stage of hospital treatment + several months after discharge). During the recovery period, it is important to follow the diet food. Patients with reduced immunity are prescribed antiviral, antibacterial, or anti-inflammatory therapy. Often poisoning is accompanied by a deficiency of vitamin, respectively, prescribed vitamin therapy.

Medicines

Medications are used exclusively on prescription, after the examination and diagnosis. Self-medication can not be done. These are basic precautions that every person who does not want to harm their health must observe. Also, this will avoid undesirable side effects. The main side effects of non-compliance with the recommendations of the doctor, is the deterioration of the disease, chronic disease, the development of comorbidities. Consider the basic drugs that can be applied when a metallic taste appears, even if you still do not know exactly what the cause of this phenomenon is.

Since the most common cause of metallic taste is, after all, poisoning, to eliminate the main symptoms of intoxication, it is recommended to take conventional activated carbon, or white coal (sorbex). Even if it is not a poisoning, it is unlikely that these drugs will cause harm. The body is always affected by a number of adverse factors, there are many internal mechanisms of intoxication. Sorbents will help to neutralize and remove them from the body. Activated carbon requires 5-6 tablets, and 1-2 tablets per day are enough for sorbex, since this is a drug of prolonged action.

Enough sorbent is enterosgel. A tablespoon of the drug is dissolved in a glass of warm water, drink once a day. This effective remedy, in addition to removing toxins, also removes slags, undigested and stagnant food, cleanses the blood, liver, removes dead and altered cells and its own organism.

Often the metallic taste is accompanied by edema, an allergic reaction. In this case, we need antiallergic, antihistamine drugs. Suprastin is the most famous, but effective. It is taken 1 tablet 1-3 times a day, depending on the severity of the edema. But this drug has a drawback - it can cause drowsiness and a slow reaction.

With strong pain, pain relievers are prescribed to relieve pain, such as spasmalgon. Drink a pill 2-3 times a day.

Vitamins

The following set of essential vitamins is recommended (daily dosage is indicated):

  • In 2-3 mg
  • PP - 60 mg
  • A - 240 mg
  • E - 45 mg
  • C - 500-1000 mg.

Physiotherapy

May be part of a comprehensive treatment, or applied independently. It all depends on the causes of the metallic taste in the mouth, the diagnosis. The main methods of physiotherapy treatment, which are used almost always and everywhere, are ultrasound treatment, infrared radiation, microcurrents, waves of various lengths, electrophoresis. Cryoprotherapy and thermal procedures are also applied.

trusted-source[22], [23]

Alternative treatment

  • Recipe number 1.

Chamomile flowers are mixed in equal parts, black currant fruit, sapling grass, pine needles and forest pine buds, creeping thyme grass, bearberry leaves, poured with boiling water (200-250 ml), infused for at least an hour, used for rinsing the throat and mouth during the day. You can add to taste honey or sugar.

  • Recipe number 2.

Take 2 tablespoons of adonis spring grass, rhizome of the marshland swamp, inflorescences of sandy immortelle, flowers and fruits of red hawthorn. Pour with cold water, bring to a boil. After the broth boils, boil for about 3-4 minutes. Remove from heat, cool to a warm state. Rinse the throat, mouth cavity during the day.

In order to reduce the discomfort of metallic taste in the mouth before menstruation, you can try to rinse your mouth with vegetable decoction, collections. Consider some effective remedies.

  • Recipe number 1.

Take a tablespoon of juniper cones, grass, mint, grass and dandelion roots, medicinal comfrey roots, male fern rootstock and shepherd's herb bag, pour 500 ml of boiling water, insist about 30 minutes. Gargle, mouth, wash the nasopharynx. The next day, you need to make a new decoction. The course of treatment is 10 days.

  • Recipe number 2.

The grass and leaves of wormwood, five-blade motherwort grass, fragrant chamomile inflorescences, black currant fruits, tvuchitsy bog grass, pour a glass of warm water, put on a weak fire or water bath. Take off, not bringing to a boil. Insist 1-2 hours, used for rinsing. You can drink 50 ml per day. The course of treatment is from 10 days.

trusted-source[24], [25]

Herbal medicine

Pomegranate pochechuyny used in inflammatory, allergic reactions, with a change in sensitivity. It is used to treat digestive disorders, eliminate intoxication. It has hemostatic properties. The main forms of application - decoction, tincture. Often added to tea, coffee, decoctions. Infusions and decoctions drink in the morning on an empty stomach.

Melilotus officinalis is often used for poisoning, as well as to overcome the effects of intoxication. Well removes spasm, swelling, and reduces pain, and also contributes to the normalization of the general state of the body.

Oregano ordinary is used to strengthen the body, increase endurance, resistance, normalizes the composition and function of blood. An excellent means of preventing viral, bacterial infections. Apply 200 ml in the morning and evening as a decoction. Dry grass poured boiling water, insist hour. Do not exceed dosage.

trusted-source[26], [27], [28], [29]

Homeopathy

When taking homeopathy, you must strictly follow the precautions, because these funds can have serious side effects. Precautionary measures - to use only after preliminary consultation with the doctor. You also need to comply with the treatment regimen, dosage.

  • Recipe number 1.

In a common alcohol (500 ml), add a tablespoon of Dagellean medicinal roots, small yellow grass and small centaury, Iceland lichen thallus. Drink a tablespoon twice a day.

  • Recipe number 2.

To prepare take on a tablespoon of calendula inflorescences drug. The bark and fruit of Viburnum vulgaris, the grass of the sapling and narrow-leaved saber-grass mulle. All this insist at least 3-4 days, drink a teaspoon 3-4 times a day.

  • Recipe number 3.

They take in equal shares the leaves of nettle, common grass shrub, pour 500 ml of alcohol. Drink a third of a glass per day.

  • Recipe number 4.

In a common alcohol (500 ml), add a tablespoon of flowers and leaves to a mother and stepmother, dandelion roots and comfrey, the rootstock of a male fern. Drink a tablespoon twice a day.

trusted-source[30], [31]

Complications and consequences

Metallic taste can be a sign of a serious and serious illness, so if you do not promptly consult a doctor, do not diagnose, you can start a serious pathology. After all, any treatment is more effective in the early stages of treatment. Moreover, there are some diseases that can be cured only in this case. If they are diagnosed in a timely manner. For example, one of the consequences of the fact that you ignore the appearance of a metallic taste can be serious diseases and complications of the kidneys and liver, including cirrhosis, hepatitis, pyelonephritis, nephritis, glomerulonephritis. Metallic taste very often indicates the development of poisoning. In most cases, this is one of the early symptoms of carbon monoxide poisoning. Without timely help, the poisoning can be fatal. Often metallic taste - a sign of cancer, or severe infectious, viral diseases, immunodeficiency. Often this taste accompanies blood diseases, including anemia, coagulation disorders, destruction of hemoglobin.

trusted-source[32], [33], [34], [35], [36]

Prevention

The basis of prevention is nutrition, maintaining an optimal balance of vitamin and mineral components. It is necessary to observe a normal drinking mode. Eat only fresh and high-quality products, which will avoid food poisoning. It is necessary to lead a healthy lifestyle, to observe the daily regimen, not to overcool, not to overwork, not to succumb to stress and depression.

An effective prophylactic for any diseases are health practices, such as hatha yoga, qigong, yogotherapy. It is important to learn proper breathing, which allows you to normalize the metabolism in the body, harmonize hormones, increase body resistance, maintain good health and mood.

trusted-source[37], [38]

Forecast

If you have a metallic taste in your mouth - you need a survey. This may be a sign of poisoning, or a sign of the disease. In most cases, with timely treatment, the prognosis will be favorable. If nothing is done, the situation may worsen, and then the forecast will be unpredictable.

You are reporting a typo in the following text:
Simply click the "Send typo report" button to complete the report. You can also include a comment.