Differential Diagnosis for Ammonia Smell

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI): This is often the first consideration for an ammonia smell, as bacteria in the urine can break down urea into ammonia, leading to the characteristic odor.

Other Likely Diagnoses

• Dehydration: Concentrated urine can have a stronger ammonia smell due to the higher concentration of urea.
• Diet: Certain foods, such as asparagus, can change the smell of urine to be more pungent or ammonia-like.
• Kidney Stones: The concentration of minerals in the urine can sometimes give off a strong, ammonia-like smell.

Do Not Miss Diagnoses

• Diabetic Ketoacidosis (DKA): Although less common, DKA can cause a fruity or ammonia-like smell in the breath and urine due to the production of ketones.
• Ureteral Obstruction: This can lead to urinary stasis, allowing bacteria to proliferate and produce ammonia.

Rare Diagnoses

• Maple Syrup Urine Disease: A rare genetic disorder that causes the urine to smell sweet, like maple syrup, but can sometimes be mistaken for an ammonia smell due to the metabolic byproducts.
• Phenylketonuria (PKU): Another genetic disorder that can cause a musty smell in the urine, which might be confused with ammonia.
• Medication Side Effects: Certain medications can alter urine smell, though an ammonia smell is less common.