Which condition could lead to a sweet or fruity smell in urine?

The presence of ketones in urine is associated with a sweet or fruity smell. Ketones are produced when the body breaks down fat for energy instead of using carbohydrates, which can occur in conditions such as uncontrolled diabetes mellitus, prolonged fasting, or starvation. When the concentration of ketones in the urine becomes high, it can lead to a distinct sweet odor due to the presence of acetone, one of the ketone bodies.

In contrast, other conditions do not typically produce a sweet or fruity aroma in urine. The presence of ammonia, which can give urine a strong, pungent scent, is more related to dehydration or concentrated urine rather than any fruity smell. High fiber diets may impact the odor of urine due to increased fermentation of fiber, but they do not generally cause a sweet smell. Bacterial infections can lead to foul-smelling urine, potentially described as musty or pungent, rather than sweet. Thus, the presence of ketones is specifically linked to the fruity odor noted in certain metabolic conditions.