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Last updated: July 23, 2025View editorial policy

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Differential Diagnosis for Dark Colored Urine

  • Single most likely diagnosis
    • Dehydration: This is the most common cause of dark-colored urine. When the body is not taking in enough fluids, the urine becomes more concentrated, leading to a darker color.
  • Other Likely diagnoses
    • Blood in the urine (Hematuria): The presence of blood in the urine can cause it to appear dark or tea-colored. This can be due to various reasons such as urinary tract infections, kidney stones, or bladder infections.
    • Liver disease: Certain liver conditions, like cirrhosis or hepatitis, can cause changes in urine color due to the buildup of bilirubin, a yellow pigment that can turn urine dark.
    • Medications: Certain medications, such as rifampicin (an antibiotic) or metronidazole (an antibiotic and antiprotozoal), can cause urine to turn dark or brown.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Rhabdomyolysis: A serious condition where muscle tissue breaks down, releasing myoglobin into the bloodstream, which can cause urine to turn dark brown or tea-colored. If left untreated, it can lead to kidney failure.
    • Malignant melanoma: In rare cases, melanoma can cause urine to turn dark due to the presence of melanin. Although rare, it's crucial to consider this possibility to avoid delayed diagnosis.
  • Rare diagnoses
    • Alkaptonuria: A rare genetic disorder that affects the breakdown of certain amino acids, leading to the accumulation of homogentisic acid, which can cause urine to turn dark or black upon standing.
    • Porphyria: A group of rare genetic disorders that can cause changes in urine color, including darkening, due to the accumulation of porphyrins.
    • Blackwater fever: A rare complication of malaria, characterized by the presence of dark urine due to hemolysis (breakdown of red blood cells).

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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