Differential Diagnosis for Urine Smelling like Sulphur

• Single most likely diagnosis
  • Urinary Tract Infection (UTI) with bacteria that produce volatile sulfur compounds: This is the most common cause of urine smelling like sulphur. Bacteria such as E. coli, Klebsiella, and Proteus can break down urine components, leading to the production of sulfur-containing compounds.
• Other Likely diagnoses
  • Dehydration: Concentrated urine can have a stronger, more unpleasant odor, which may be perceived as sulphur-like.
  • Dietary factors: Consuming foods high in sulfur, such as garlic, onions, or cruciferous vegetables, can lead to urine with a sulphur-like odor.
  • Medications: Certain medications, such as trimethoprim-sulfamethoxazole, can alter urine odor, making it smell like sulphur.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Diabetes: Uncontrolled diabetes can lead to diabetic ketoacidosis, which can cause a sweet, fruity, or sulphur-like odor in urine.
  • Liver or kidney disease: Advanced liver or kidney disease can lead to the accumulation of waste products, resulting in a strong, unpleasant urine odor, potentially resembling sulphur.
• Rare diagnoses
  • Maple syrup urine disease: A rare genetic disorder that affects the body's ability to break down certain amino acids, leading to a sweet, maple syrup-like or sulphur-like odor in urine.
  • Trimethylaminuria: A rare genetic disorder that affects the body's ability to break down trimethylamine, leading to a strong, fish-like or sulphur-like odor in urine, sweat, and breath.